How Long Will It Take Melasma to Fade Once I Stop Taking Birth Control?

Question

I have never had any problems with melasma before until I started back on bc for accutane. I am 27, have been off both accutane & bc for 2 months, and it still has not faded away! Will this be permanent or something that will fade, but still come back later on?

Raffy Karamanoukian, MD, FACS · Answer

Melasma often does not resolve once birth control pills are stopped. I would begin treatment with the Melarase skin lightening creams prior to stopping your birth control. Raffy Karamanoukian, Los Angeles

Shlomit Halachmi, MD, PhD · Answer

Melasma is discoloration of the upper cheeks, upper lip, or forehead, most commonly seen in women of childbearing age.  It tends to develop during pregnancy (hence its nickname "the mask of pregnancy") or while taking a birth control pill.  Regardless, its onset is triggered by the combination of estrogen and sun exposure.  No sun - no melasma.
Melasma is like a light switch, except one it is turned on, it can't be turned off... Stopping birth control pills will not make the melasma resolve completely.  After all, you still make estrogen...
That does not mean melasma can't be treated successfully.  The key is to avoid sun exposure strictly: avoid the sun in peak hours, use a broad-spectrum, high SPF (50+) sunscreen, applied liberally, and reapplied often, and wear a hat with a good brim.  Studies show that this alone is the main factor in reducing the darkness of melasma.  
You can also see a dermatologist to discuss treatments such as hydroquinone, which blocks the key enzyme that makes melanin, the brown pigment in the skin.
Avoid treatments such as peels and laser - these may provide temporary benefit, but the melasma will always come back.  In addition, those treatments may in themselves cause change in your skin color (post-inflammatory hyperpigmentation).

Dina D. Strachan, MD · Answer

This question is difficult to answer as sometimes melasma resolves when birth contol is stopped and sometimes it does not.  Make sure you use a sunscreen with an spf of 30 or higher daily and avoid strong sun.  You might also want to try a hydroquinone product, chemical peels and or a skin brightener.  I recommend a consultation with a board-certified dermatologist.

Davin Lim, MBBS, FACD - Account Suspended · Answer

You may be very lucky and be in the 5% of patients that have self resolution of melasma, however most patients will still have melasma after OCP cessation. Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher.

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Real Self Advisory Board

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