How to remove melasma from chest area?

Question

Hi I have melasma on my chest area pretty bad. I freckle very easily also. I use sunscreen but it is still bad on the chest area. I am allergic to hydroquinone and cant seem to use kojic acid or any topical without getting very red , swollen and bumpy. I tried ipl which made it worse. Is there anything I can do to get rid of this??

Harold J. Kaplan, MD · Answer

Hi CC.  Melasma does not normally occur on the chest.  It's very likely that what you are describing is a condition called Poikiloderma.  Poikiloderma is a darkening of the neck and chest related to long term sun exposure that normally occurs in lighter skin types.  It can have both vascular (red) and pigmented (brown) components to it and therefore we use both pulsed dye and q-switched lasers.  Although the condition is difficult to treat, lasting improvement can be had with the right type of laser technology (IPL is not a laser).

Raffy Karamanoukian, MD, FACS · Answer

Melasma can make your skin look mottled and hyperpigmented. Melasma is usually caused by endogenous and exogenous hormones, the sun, inflammation, and possibly thyroid dysfunction. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of light fractional laser, depigmenting lasers and IPL, vascular pulsed dye laser, and Covalent peels. 
  
Recommended Creams: Melarase Brightening Kit
  
MelaClenz
  Melarase AM
  Melarase PM
  Melapads
  Replenish Retinoid Cream
  Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Michele S. Green, MD · Answer

Melasma is a common problem that has a solution.  Depending on the severity of Melasma it can be treated with topical therapy alone, or Cosmelan (with or without hyroquinones) or chemical peels. I would suggest you consult a board certified dermatologist with experience in Melasma for the best cosmetic treatment.

Jody Comstock, MD · Answer

Chest melasma is uncommon, but could occur.  Most likely if you have it on your chestyou have it on your face.   Many of the topical products used to treat melasma canbe irritating and the chest is always extra sensitive to topicals.  The discoloration could simply represent old sundamage and have that deep, darker color.  Individuals that freckle have less genetic protection from the sun, so physical protection from clothing is your best bet.  During the day, we recommend wearing a shirt that covers the chest.  Physical sunblocks with zinc oxide or titanium dioxide are excellent, but the direct heat and incident UV penetration can still damage the skin.  You could try some of the non-hydroquinone products, such as Lytera, but the chest may respond best to microdermabrasion with ultrasound non-HQ Bleach and Retin A or a series of light chemical peels.  It is not uncommon to have lasers and light sources create rebound hyperpigmentation.  I would definitely have you see a cosmetic dermatologist as you may need hormones checked if this truly is melasma and having rebound hyperpigmentation can be a challenging issue.

Manjula Jegasothy, MD · Answer

Melasma is extremely uncommon on the chest. Brown pigmentation on the chest is most commonly due to chronic mild sun exposure, such from wearing V-neck shirts. Nd:Yag laser can be very effective for this type of brown pigmentation, but often needs to be repeated once or twice every year.

How to remove melasma from chest area?

Answers (5)

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