Best Melasma Treatment

Melasma is a common skin condition that is characterized by brown or gray-brown patches of skin that are darker in color than the rest of the surrounding skin. The most commonly affected areas include the forehead, cheeks, upper lip, nose, and chin. Although melasma isn’t harmful, developing dark patches on your skin can be alarming, frustrating, and leave many people self-conscious. Luckily, board-certified dermatologist Dr. Michele Green offers a host of non-invasive treatment options, like chemical peels, Cosmelan, Mesopeels, VBeam, and Helios 787 laser treatments, and specially formulated topical skincare products, such as hydroquinone and tretinoin, to help her patients reduce excess pigment and achieve a healthy, clear, even skin tone.

Melasma develops due to an overproduction of melanin in concentrated cells of the skin via melanocytes (melanin-producing cells). While the exact cause of melasma remains unknown, factors such as frequent or prolonged sun exposure, genetics, and hormone changes have been linked to excess pigment production in the skin. Even with daily sunscreen use, sometimes it seems as though sun spots, age spots, hyperpigmentation, and melasma are simply unavoidable. In the private dermatology office of Dr. Green, located in NYC’s Upper East Side, melasma is one of the most commonly treated skin conditions. Regardless of gender, skin tone, and skin type, patients with melasma often tend to feel self-conscious about the cosmetic appearance of concentrated pigment patches. If you’re frustrated by the appearance of melasma or other forms of hyperpigmentation, board-certified cosmetic dermatologist Dr. Michele Green is here to help.

Dr. Michele Green in New York City is an internationally renowned board-certified cosmetic dermatologist with over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive treatment options, including to reduce melasma and hyperpigmentation. She takes a holistic approach and embraces a less-is-more philosophy regarding facial rejuvenation. She customizes

Each patient’s treatment plan should suit their unique skin concerns and overall aesthetic goals best. Dr. Green is consistently identified as one of NYC’s best dermatologists by Castle Connolly, New York Magazine, the New York Times, and Super Doctors for her dedication to her patients and expertise. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will work with you to create a melasma treatment plan that best suits your skin type, particular needs, and skin tone to provide you with a healthy, clear, radiant complexion that lasts.

What is Melasma?

Melasma is a common skin condition characterized by blotchy brown, dark brown, or gray-brown patches of skin that are darker in color than the surrounding skin. The areas of the face that are most commonly affected by melasma are the upper lip, cheeks, the bridge of the nose, and the forehead. Although melasma primarily affects the face, in some patients, it may develop on the forearms or the neck. Since sun exposure is one of the major contributing factors to the development of melasma, it may appear in any area of the body that has had significant sun exposure. For the same reason, melasma can appear darker in the warmer summer months when skin is exposed to more UV light from the sun, and it can tend to fade somewhat in the winter. If you have noticed patches of hyperpigmentation on your skin that resemble melasma, consulting with Dr. Green in NYC is the best way to develop a plan to reduce their appearance.

There are three different categories of melasma: epidermal melasma, dermal melasma, and mixed melasma. There used to be a diagnostic test called the Wood’s lamp examination technique in which a black light was utilized to determine the depth of the pigment. Now, there is no such lamp required to determine which form of melasma a patient is experiencing, and Dr. Green can use clinical evaluation exclusively to diagnose melasma. In cases of epidermal melasma, the pigment is in the superficial layer of the skin- the epidermis. In dermal melasma, the excess pigment is located in the middle layer of the skin- the dermis. In mixed melasma, the most common type of melasma, the pigment is present in a combination of dermal and epidermal melasma. Dr. Green takes the time required to understand you and your unique skin concerns, family history, and cosmetic goals to develop a treatment plan that best caters to your needs and results in long-lasting, clear, beautiful skin.

What causes melasma?

The exact underlying cause of melasma remains unknown. However, several contributing factors have been identified to lead to the development of melasma, including sun exposure, genetics, and hormone changes. Melanin is a component of the skin that is responsible for pigmentation. Melanocytes are the skin cells that are responsible for producing melanin. Melasma has been found to occur when melanocytes are overstimulated and produce too much melanin, resulting in blotchy, discolored patches of skin that are darker than the rest of the face. Melasma patches typically appear on the forehead, upper lip, and cheeks. Still, they can also affect the chin, nose, neck, back, and arms. While the underlying cause of melasma remains unknown, some groups of people tend to be more affected by the appearance of melasma than others. The majority of those who struggle with the arrival of melasma are women. While there are men who may experience melasma, according to the American Academy of Dermatology, just 10% of individuals who develop this skin condition are men.

Melasma is also more commonly found in those with a light to medium brown skin tone (Fitzpatrick skin types III and IV) and darker skin tones (Fitzpatrick skin types V and VI) than those patients who have fairer skin tones. Individuals with darker skin are more susceptible to melasma because there are more melanocytes present in brown skin, meaning that there is a greater potential for making a larger amount of melanin than there is in lighter skin. Additionally, those with a family history of melasma or facial hyperpigmentation are more likely to develop this skin condition. A family history of pigmentation or melasma indicates that there may be a genetic component involved in developing melasma.

While there has yet to be a precise, identifiable cause of melasma, there are some factors that contribute to an increased likelihood of developing the notifiable dark patches of melasma. Sun exposure and hormone changes are two of the largest contributing factors to the onset of melasma.

Sun exposure is by far the most common trigger in regard to the onset of facial melasma. Ultraviolet light, both the UVA and UVB rays from the sun, stimulates the melanocytes to produce more melanin. Preventing excess melanin production is one of the many reasons why it is so important to limit sun exposure and practice complete sun protection, including using a broad-spectrum sunscreen daily with an SPF of 50 or higher. It is also critical to avoid the damaging effects of these UV rays to prevent the recurrence of melasma after it is treated. Even small amounts of sun can cause a recurrence of your melasma.

Hormone changes, particularly a surge in the levels of the female sex hormones estrogen and progesterone, have also been linked to the development of melasma. It has been found that the use of birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy can all cause melasma to flare since they impact estrogen and progesterone levels in the body. Melasma is often referred to as the mask of pregnancy due to the increased amount of melanin and hyperpigmentation occurring on the faces of pregnant women. Dr. Green often recommends discontinuing oral contraceptive pills in patients with melasma to improve the appearance of this skin disorder.

Thyroid disease and melasma have also been shown to be linked. Currently, it is thought that thyroid disease may be a cause of melasma in some patients, as many patients with melasma are also diagnosed with thyroid disease. Studies have shown elevated serum TSH, anti-thyroid peroxidase, and anti-thyroglobulin antibodies in patients who are suffering from melasma. In fact, the frequency of thyroid disease is four times higher in patients with melasma compared with the general population.

Cosmelan: 10 weeks before & after

Is Melasma genetic?

Though melasma is a skin condition that is largely attributed to a combination of hormone changes and sun exposure, some epidemiological studies have shown that genetic factors do contribute to the presence of melasma, too. Many patients who struggle with melasma have a genetic predisposition for the same skin condition. It has been observed to run in families, with nearly half of female melasma patients reporting that they have a family member who also has a skin condition. Women are much more likely to develop melasma than men, and patients with darker Fitzpatrick skin types are more inclined to have melasma than patients with lighter skin types. The presence of melasma can not be attributed to any singular causal factor but rather a combination of contributing factors, including genetics.

Can stress cause melasma?

While controversial, the stress hormone cortisol is thought to be linked to the development of melasma. Chronic, long-term stress can cause an increase in the prevalence of hormones associated with melanin (pigment) production. More research is required to determine the exact underlying cause of melasma. Other factors, including pregnancy, thyroid disease, UV exposure, and certain medications, can trigger the development of melasma. Additionally, some individuals are more prone to developing melasma than others. Individuals with medium to dark skin tones are more susceptible to developing melasma than those with lighter skin tones. Women are more likely to get melasma than men, representing nine out of every ten patients with the skin condition. It’s also thought to have a genetic component, with several studies reporting that many patients with melasma also have a relative with the same skin condition.

Can Birth control pills cause Melasma?

Hormone changes, specifically in levels of the female hormones estrogen and progesterone, have been linked to the development of melasma. Oral contraceptives commonly contain these hormones to aid in the prevention of pregnancy and may contribute to the development of melasma. As a result of increased levels of estrogen and progesterone, melanocytes (the skin cells responsible for producing melanin) increase in number and make one even more sensitive to the ultraviolet rays of the sun.

While sun exposure certainly triggers melanocytes to produce more melanin, other factors, such as medications and other hormone changes, can trigger or worsen melasma. Additionally, the hormones that are the basis for oral contraceptives are involved in the direct exacerbation of melanocytes, working to increase the total amount of pigment produced. This results in the overproduction of melanin and the appearance of hormone-related melasma.

Discontinuing the use of oral contraceptives can help to lighten existing melasma and improve your complexion. Non-hormonal methods of birth control are much less likely to trigger the development of melasma. It is always important to use sunscreen while on birth control pills, as this medication, like other photosensitizing medications, can exacerbate underlying pigmentation. During your consultation with Dr. Green, she will collect a thorough medical and family history in addition to physically evaluating your skin condition. Depending upon her evaluation, Dr. Green may request certain laboratory tests be performed to evaluate for hormone changes that could be linked to your melasma. If necessary, Dr. Green may coordinate your care with your GYN to limit the influence of oral contraceptives on the prevalence of your melasma.

Cosmelan 11 months before and after

Is Melasma cancerous?

No! Melasma itself is not a dangerous skin condition. Melasma is an incredibly common skin disorder that Dr. Green has over 25 years of experience treating. There is no potential for melasma to evolve into a skin cancer or otherwise harmful skin condition. However, some skin cancers exist which may resemble melasma in some way. If you are concerned about a brown patch or dark patches of skin and are unable to discern whether it is a skin cancer or a patch of melasma, schedule an appointment with a board-certified dermatologist like Dr. Green. In your work, Dr. Green will first thoroughly discuss your medical and family history with you, then proceed to clinically evaluate the areas of hyperpigmented skin to rule out any dangerous skin conditions. A skin biopsy may be performed and sent to the laboratory for further examination as part of a routine check to rule out melanoma and other varieties of skin cancer, should it be necessary. Also, if you notice any other symptoms that onset at the same time that you develop visible melasma, please contact Dr. Michele Green for proper evaluation and treatment.

How to treat melasma

Since melasma can be an incredibly challenging skin condition to address, one of the best treatments for melasma is preventative treatment. Preventative treatment of melasma typically comes down to limiting sun exposure and discontinuing the use of any medications and skincare products that may be contributing to the presence of melasma. These methods of prevention can help stop the development of melasma as well as dark spots and other forms of hyperpigmentation. Dr. Green always recommends wearing a daily broad-spectrum sunscreen with an SPF of 50 or higher. The best way to prevent the formation of unwanted pigmentation and signs of premature aging, as well as to lower the risk of developing skin cancer, is to protect the skin from the sun’s harmful UV rays.

When unwanted melasma or hyperpigmentation does appear on the skin, the best treatment option available is often a unique combination of topical skincare treatments and in-office procedures. There are several different treatment options available for treating the appearance of melasma. Topical skin lightening products, chemical peels, microdermabrasion, microneedling with depigmentation serums, VBeam and Helios 787 laser treatments, and Cosmelan peel treatments are just a few of Dr. Green’s favorite ways to address dark patches of skin caused by melasma. Ultimately, the right treatment for your melasma will depend on your skin type, skin tone, and the type of melasma that you are experiencing.

Do Chemical Peels Help Melasma?

A chemical peel is a type of skin resurfacing treatment that can improve skin tone and texture. During a chemical peel, Dr. Green applies a chemical solution to the skin’s surface in order to gently and effectively remove the epidermal layers of discolored, dead skin. This method of chemical exfoliation stimulates skin cell turnover, resulting in unclogged pores and the correction of discolored skin, revealing a vibrant, healthy glow. Dr. Green can tailor a chemical peel treatment to the needs and goals of each of her patients. Depending on the strength and type of chemical peel used, it is possible to achieve an improvement in skin texture, minimization of an acne breakout or appearance of acne scars, or diminishment of sun damage, fine lines and wrinkles, and melasma.

For her patients who experience sun damage and irregularities in pigment, such as hyperpigmentation or melasma, Dr. Green often recommends a TCA peel. In her Upper East Side office, TCA peels, or trichloroacetic acid peels, are offered in a range of strengths and combinations. Dr. Green frequently incorporates chemical peel treatments, in conjunction with hydroquinone creams and tretinoin, into the treatment plans of her patients with melasma. This combination approach helps to exfoliate the skin and enhance the results from a chemical peel treatment.

Chemical Peels can be used to target specific skin care needs by carefully adjusting the range in depth and intensity of treatment. Board-certified dermatologist Dr. Michele Green has over 25 years of experience treating some of the most discerning men and women from around the world with chemical peels to provide them with smooth, clear, beautiful skin. When you have a consultation with Dr. Green, you will have the opportunity to talk about your specific skin concerns and cosmetic goals. When developing a treatment plan for you, Dr. Green will customize your protocol based on your skin type, skin tone, and the degree of your hyperpigmentation.

Cosmelan 8 months before and after

Cosmelan Peel for Melasma

Dr. Michele Green is an internationally renowned expert in cosmetic dermatology with over two decades of experience treating melasma and other forms of hyperpigmentation on the face and the body. She takes a special interest in depigmentation treatment that, in part, stems from meeting with patients who, in the past, were incorrectly treated with laser treatments such as Fraxel laser or IPL, resulting in a worsened appearance of the original hyperpigmentation. These laser treatments can push the pigment deeper into the dermal layers of the skin, making it more difficult to remove. Dr. Green finds that most cases of melasma and hyperpigmentation are best treated with procedures such as chemical peels, Cosmelan, Mesopeels, and other more appropriate cosmeceuticals and skincare. If laser treatments are used for treating melasma, certain technology and precise settings must be used.

For this reason, it is critical to consult an experienced board-certified dermatologist like Dr. Green regarding laser treatment for melasma. In addition, dark spots or post-inflammatory hyperpigmentation from acne can be treated effectively with Cosmelan and chemical peels. The following list is composed of the main conditions that Cosmelan treats:

• Melasma
• Sunspots
• Sun damage
• Acne scarring
• Age spots
• Post-Inflammatory hyperpigmentation
• Skin discoloration on chest, neck, and back
• Blemishes
• Uneven skin tone
• Discoloration from laser treatments such as Fraxel, IPL, and Picosure laser

The Cosmelan® peel is a two-part professional-grade mask that Dr. Green applies in her practice on the Upper East Side of Manhattan. The mask is left in place for a number of hours, the total of which is determined by Dr. Green, depending on the degree of pigmentation, skin tone, and skin type. The cream mask is easily removed at home by the patient using a gentle facial cleanser. Cosmelan® produces an initial “peeling” of the skin, which will leave the skin smooth and also work to decrease the signs of facial hyperpigmentation dramatically. Dr. Green loves Cosmelan® because it is a simple and safe treatment option with minimal downtime that provides phenomenal results, helping patients feel and look like the best version of themselves. The patient then returns four weeks after their initial melasma treatment for re-evaluation and, depending on Dr. Green’s assessment, potentially a touch-up of Cosmelan® to treat any residual hyperpigmentation.

A series of creams, including kojic acid, azelaic acid, hydroquinone, hydra-vital factor K (Vitamin K cream), Cosmelan 2 cream, and sunscreen, are used at home after the Cosmelan mask is removed to maintain the effects of the procedure and keep the skin clear and free of excess pigment. Strict sun avoidance is imperative, and patients must practice proper sun protection, including the use of sunscreen with an SPF of 50 or higher. Dr. Green recommends layering two different sunscreens for patients with melasma. She recommends using a chemical-based sunscreen, such as one that contains oxybenzone, as well as one that includes a physical block, such as zinc oxide or titanium dioxide. Sunscreen use is paramount throughout the treatment of melasma and afterward in order to avoid the recurrence of dark patches of melasma and hyperpigmentation.

The most common side effects of the Cosmelan peel include mild facial redness, dryness, and minimal peeling. These side effects normally resolve on their own within several days of treatment. Dr. Green’s Anti-Wrinkle Recovery cream, combined with the unique Vitamin K cream, will both effectively help minimize any. If there is skin irritation in areas where Cosmelan 2 is being applied throughout the at-home portion of the treatment, alert Dr. Green, who can make any necessary adjustments to your regimen. Signs of skin irritation can include persistent redness, peeling, stinging, or burning. Continuing to use the Cosmelan 2 cream when the skin is irritated can damage the skin and worsen the appearance of melasma.

A question that patients with melasma often present to Dr. Green is: can Cosmelan treatment make melasma worse? The answer is no; Cosmelan will not make melasma worse. Dr. Green considers Cosmelan treatment the best depigmentation treatment available to improve melasma. Certain laser treatments such as Fraxel laser, Intense Pulsed Light Therapy (IPL), and CO2 or other fractionated lasers, however, can make melasma worse. It can be more difficult to remove melasma after having an inappropriate laser treatment, but Dr. Green has had remarkable success using Cosmelan to correct the appearance of exacerbated melasma.

Does microneedling help melasma?

Microneedling, or collagen induction therapy, is a safe and effective treatment option for improving skin tone and texture. It can also help reduce the appearance of melasma, especially when paired with a specially formulated depigmentation serum. This minimally invasive cosmetic procedure entails the provider using a handheld device containing tiny, sterile microneedles to deliver controlled trauma to the skin’s surface layers. This process stimulates the skin’s natural wound-healing process, increases the absorbancy of certain skincare products, and accelerates the rate of skin cell turnover, resulting in a smoother skin texture and a brighter, more even skin tone. Most patients require a short series of 3-6 microneedling treatment sessions, each spaced one month apart, to achieve optimal skin rejuvenation results. Patients appreciate the fact that there is minimal downtime and side effects, with the most common being mild redness and swelling in the treatment area.

When it comes to treating melasma and other types of hyperpigmentation with microneedling, the most important aftercare consideration is to avoid sun exposure in the affected area. Any kind of skin resurfacing treatment, including microneedling, can increase the skin’s photosensitivity as it heals, making it more susceptible to UV damage and worsening hyperpigmentation. Sunscreen can not be applied to the treatment area for 24 hours, meaning patients should avoid sun exposure altogether or wear sun-protective clothing during that time. Hyaluronic acid serum is the only skincare product that should be applied to the treatment area 24 hours after microneedling. Hyaluronic acid is a humectant ingredient that promotes hydration and better healing. When you have microneedling with Dr. Green for melasma or hyperpigmentation, she will recommend a skincare regimen for you that is catered to your skin condition, specific concerns, aesthetic goals, and skin type.

Laser treatments and Melasma

If laser treatment is used to improve the appearance of melasma, the appropriate technology and settings must be used. Too often, patients have laser treatments to try and remove melasma, only to result in worsening the appearance of the melasma and hyperpigmentation. Melasma can be even more difficult to remove after a laser has been used to treat it because certain types of laser treatments can cause hyperpigmentation to become even more entrenched in the deeper dermal layers of the skin. For example, the PicoWay and Piscosure lasers have been demonstrated to improve the appearance of melasma and are FDA-approved for treating it. Other types of laser treatments, including intense pulsed light (IPL) and CO2 lasers, can worsen the appearance of melasma and should not be used on patients with the skin condition. Unwanted side effects from inappropriate laser treatments for melasma include worsening hyperpigmentation, burning, and scarring.

Dr. Green treats melasma with Mesopeels, chemical peels, VBeam laser treatment, the Helios 785 Picosure laser treatment, and Cosmelan peels to prevent any worsening of the already existing hyperpigmentation. Cosmelan treatment was initially developed to treat melasma exclusively. However, Dr. Green has expanded its use to incorporate the peel into the treatment of acne scars, post-inflammatory hyperpigmentation (PIH) from lasers, sun spots, sun damage, and other discoloration on the face, neck, chest, back, and other areas of the body, including the arms and legs.

Helios 787 Picosure Laser Treatment for Melasma

The Helios 785 is a Picosure laser treatment that was FDA-approved to treat hyperpigmentation in 2022. It is a Q-switched Nd: YAG laser with Pico and Nanotechnologies, which allows it to target various skin conditions, including melasma. It operates on two distinct wavelengths, 532 and 1064 nm, giving it the ability to address both epidermal and dermal melasma and making it an excellent treatment option for patients who have not had success with topical treatments. With multiple handpieces and wavelengths of laser energy that can be utilized, it’s relatively easy for providers to tailor each laser treatment to a given patient’s skin tone and skin type. Clinical research has shown the Helios 785 laser to be a safe and effective treatment option for Asian skin types and individuals with Fitzpatrick skin Type III-IV. When seeking treatment for melasma, it is critical to consult with a board-certified dermatologist, such as Dr. Green, to ensure that the appropriate type of laser treatment and settings are used so the skin condition does not worsen. Using inappropriate laser technology or settings for a given patient can result in worsening hyperpigmentation, burning, and scarring. Dr. Green is an expert in melasma treatment with over two and a half decades of experience helping her patients achieve clear, radiant complexions with even skin tones. She will work with you to ensure you get the best results from your laser treatment for hyperpigmentation.

What is the Best Sun Protection for Melasma?

Sun protection plays an essential role in both preventing melasma from forming in the first place and controlling the appearance of melasma after Dr. Green has treated it. Dr. Green suggests always choosing a broad-spectrum sunscreen. Broad-spectrum sunscreen offers protection against both UVA and UVB rays from the sun that may trigger melanocytes in the skin to produce melanin. Dr. Green’s very own Hydrating SPF 50, from her MGSKINLABs Inc. line of products, provides broad spectrum coverage and a smooth, silky finish to ensure sun protection and comfort. Patients with melasma should remember that visible light can enter through the glass. Their hyperpigmentation may worsen if they do not protect their skin from exposure while driving their car or sitting near a window.

Sunscreen must be reapplied every hour and a half to two hours to ensure proper coverage and protection. Additionally, you can layer your sunscreens to provide maximum protection. First, apply a chemical sunscreen that will absorb into the skin. Chemical sunscreens work by absorbing heat energy from the sun’s rays and undergoing a chemical reaction within the skin. Next, layer on a physical or mineral sunscreen. These sunscreens will normally include ingredients such as zinc oxide or titanium dioxide and work by sitting atop the surface of the skin, acting as a barrier against harsh UV rays. By layering both a chemical and a physical sunscreen, one can ensure that they are doing their best to protect their skin from the sun and prevent the development or exacerbation of melasma. Wearing a wide-brimmed hat is an excellent way to maximize your sun protection and help prevent melasma from worsening or returning.

Patients with melasma must be extremely careful with the sun, as any sun exposure can worsen melasma and mitigate the results of melasma treatment. Avoiding sun exposure and using proper sun protection is vital for maintaining optimal cosmetic results following melasma treatment. A broad-spectrum sunscreen with a minimum SPF of 50 should be used to protect against both UVA and UVB rays. For maximum protection, Dr. Green recommends to her patients that they utilize two types of sunscreen: layering a chemical sunscreen and then a physical sunscreen for the best protection.

Chemical sunscreens contain active ingredients, such as oxybenzone, octinoxate, or avobenzone, that are absorbed into the skin and prevent damage from the sun by inactivating UV rays through a chemical reaction. Physical sunscreens contain mineral ingredients like titanium dioxide or zinc oxide and sit atop the skin like a barrier to prevent UV rays from penetrating deeper layers of skin. Using the two different types of sunscreens simultaneously will offer the best coverage and help prevent melasma recurrence. Sunscreen should be reapplied every 90 minutes and after water activities. Sunscreen should be applied daily regardless of the weather, as UV rays can reflect off of puddles and snow. Patients should stay in the shade and wear a wide hat that covers their entire face. For patients with severe melasma, using a UV-blocking umbrella can help to provide maximum protection from sun exposure.

Cosmelan 6 weeks before and after

Which Topical Skincare Cream is Best for Melasma?

For her patients with melasma, Dr. Green often recommends a combination of in-office treatment options and at-home skincare products to diminish visible dark patches overall and produce a clear, beautiful, long-lasting complexion. Some of the most effective topical products for melasma include sunscreen, hydroquinone, retinol, and vitamin C.

Hydroquinone for Melasma Treatment

Hydroquinone is an ingredient in skin-bleaching creams that helps to lighten areas of hyperpigmentation and melasma. Hydroquinone is no longer available in any over-the-counter products. However, Dr. Green can provide her patients with prescription-strength Hydroquinone creams from a specialty compounding pharmacy as part of their melasma and pigmentation treatment plan. Hydroquinone creams can be compounded with Retin-A or other active ingredients in different strengths. The strengths of hydroquinones vary from 4% to 10% in treating some difficult pigmentation. Dr. Green may also recommend cysteamine or tranexamic acid as skin-lightening ingredients as a bleach-free alternative to hydroquinone. A study published in J Am ACAD Dermatol demonstrates that cysteamine is a viable treatment for melasma for patients who do not wish to be treated with hydroquinone.

Do Retinol and Tretinoin Help with Melasma?

Yes! Retinol can be a helpful skincare ingredient for patients with melasma. Retinol and retinoids work by increasing the rate of skin cell turnover, stimulating new collagen production, and exfoliating away dead, discolored skin cells to reveal the underlying healthy, new skin cells. Over time, with consistent retinol use, an observable improvement in skin tone and texture can be achieved. Tretinoin is a prescription-strength derivative of vitamin A that is not available over the counter and must be prescribed by a certified healthcare provider. Patients with sensitive skin types may find retinol or tretinoin to be irritating to the skin, potentially causing redness, flakiness, stinging, dermatitis, or exacerbating hyperpigmentation. Corticosteroids can only be used for a short period because topical steroid creams can cause thinning of the skin. Before starting with a new skincare product to treat melasma, it is always recommended to consult a dermatologist, such as board-certified dermatologist Dr. Green. Dr. Green will provide you with a skincare regimen that’s best suited to your skin type, personal concerns, and aesthetic goals.

Does Vitamin C Help with melasma?

Vitamin C is a powerful antioxidant with many renewing properties, making it a great addition to one’s daily skincare routine. In addition to improving overall skin tone and texture by stimulating new collagen production and skin cell generation, vitamin C impedes melanin production by blocking the formation of the enzyme tyrosinase. Dr. Green’s MGSKINLABs Vitamin C formulation, the Vita-C serum, contains a high concentration of Vitamin C and is designed to promote skin cell renewal and collagen synthesis, resulting in reduced appearance of hyperpigmentation and a clearer, healthier complexion. It’s no wonder that Dr. Green’s Vitamin C serum is her office’s most popular topical skincare product. Vitamin C also enhances protection against the sun’s UV rays and, as an anti-inflammatory ingredient, has soothing properties that make it a great treatment option for rosacea. While Vitamin C is an excellent addition to your standard skincare regimen, other cosmetic treatment options may be better suited to efficiently reducing the appearance of melasma. Depending on her assessment of your skin condition during your initial consultation, Dr. Green may recommend treatment options such as microneedling with depigmentation serum, Mesopeels, or Cosmelan peels.

What is the Best Treatment for melasma?

The best way to treat melasma is to start by consulting an experienced board-certified dermatologist, such as Dr. Michele Green, in NYC. Melasma is a complicated skin condition, and many of the traditional methods used for treating other types of hyperpigmentation, such as certain laser treatments, can exacerbate its appearance or make it more difficult to remove. Dr. Green is an internationally renowned expert in cosmetic dermatology with over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive treatment options, including for melasma. The treatment options selected for improving the appearance of your melasma will ultimately depend on its severity, skin type, and skin tone.

During your initial consultation, Dr. Green will obtain a thorough medical and family history, review any previous melasma treatments you may have tried, and physically assess your skin condition. Skin-lightening topical treatments and skincare products may be recommended, including those with active ingredients like vitamin C, hydroquinone, azelaic acid, kojic acid, or tretinoin. Some of the most effective in-office treatment options for melasma include chemical peels, Cosmelan peels, Mesopeels, microneedling with depigmentation serum, and the VBeam or Helios Picosure laser treatments. Usually, patients observe the best skin rejuvenation results when a personalized combination of topical skincare products and in-office treatment options are used. Dr. Green will work with you to develop a treatment plan that perfectly suits your unique concerns and aesthetic goals so that you look and feel like the best version of yourself.

What is the Best Sun Protection for Melasma?

Patients with melasma must be extremely careful with the sun, as any sun exposure can worsen melasma and mitigate the results of melasma treatment. Avoiding sun exposure and using proper sun protection is vital for maintaining optimal cosmetic results following melasma treatment. A broad-spectrum sunscreen with a minimum SPF of 50 should be used to protect against both UVA and UVB rays. For maximum protection, Dr. Green recommends to her patients that they utilize two types of sunscreen: layering a chemical sunscreen and then a physical sunscreen for the best protection. Chemical sunscreens contain active ingredients, such as oxybenzone, octinoxate, or avobenzone, that are absorbed into the skin and prevent damage from the sun by inactivating UV rays through a chemical reaction. Physical sunscreens contain mineral ingredients like titanium dioxide or zinc oxide and sit atop the skin like a barrier to prevent UV rays from penetrating deeper layers of skin. Using the two different types of sunscreens simultaneously will offer the best coverage and help prevent melasma recurrence. Sunscreen should be reapplied every 90 minutes and after water activities. Additionally, sunscreen should be applied daily regardless of the weather, as UV rays can reflect off of puddles and snow. Patients should stay in the shade and wear a wide hat that covers their entire face. For patients with severe melasma, using a UV-blocking umbrella can help to provide maximum protection from sun exposure.

Is Melasma Permanent?

The permanence of melasma depends on the individual, the underlying causes of their melasma, the severity of their skin condition, the amount of exposure they have to melasma triggers, and their skin’s response to cosmetic treatment. Since several factors may contribute to the presence of melasma, some individuals may observe that their dark patches resolve on their own. Patients who develop melasma during their pregnancy may revert to a clear complexion after the baby is born once their hormone levels stabilize. However, melasma from pregnancy is often a permanent skin condition that requires intervention to remove pigmentation. When patients experience melasma as a result of taking birth control pills, their dark spots may fade on their own after discontinuing it. For most patients with melasma, the patches of darker skin will not improve without engaging in some type of cosmetic skin-lightening treatment. Additionally, melasma can be much more difficult to remove after having a laser treatment. Laser treatments, such as Fraxel, IPL, and Picosure, may potentially cause pigment to become further entrenched in the deeper layers of the skin, exacerbating the appearance of the hyperpigmentation and making it more difficult for topical skin-lightening treatments to be as effective.

Cosmelan 1 year before and after

How to Cure Melasma from the Inside with Tranexamic acid

Treatment of melasma can take time, and using topical treatments on their own may not be the answer for every patient with melasma. For those who are struggling to tackle their melasma with topicals exclusively, there is an oral medication called tranexamic acid, which can be used as a supplement for topical melasma treatment. Tranexamic acid, which is typically used to treat women with heavy or painful menstrual cycles, also works to treat melasma by directly interfering with melanocyte action. Tranexamic acid prevents melanocytes from producing excess melanin and also from transferring the melanin to keratinocytes, preventing the development of melasma and, when used in tandem with topicals, resulting in a clear, even-toned complexion. If you would like to learn more about whether or not oral tranexamic acid is appropriate for treating your melasma, please schedule a consultation with a board-certified, expert cosmetic dermatologist, Dr. Michele Green.

How to get rid of the mask of pregnancy

It is extremely common for pregnant women to develop what is often referred to as chloasma or “the mask of pregnancy.” In pregnant women, melasma tends to appear on the cheeks, forehead, upper lip, and chin, giving the appearance of a mask. Hormone changes cause this form of melasma during pregnancy, markedly the increase in the female hormones estrogen and progesterone. Typically, melasma that develops during pregnancy resolves on its own sometime after giving birth, as the levels of estrogen and progesterone in the body return to normal. During pregnancy, there is a limited number of treatment options available for melasma, as the safety of many topical skincare ingredients and chemical peels has not been tested for pregnant women. While one is pregnant, cosmetic treatments designed to treat melasma and facial hyperpigmentation, such as the Cosmelan peel and trichloroacetic acid chemical peels, can not be used. Additionally, the majority of topical skin-lightening products (such as hydroquinone) are not to be used when pregnant.

The best way to manage any facial hyperpigmentation or melasma that you have during pregnancy is to use the proper sunscreen (with an SPF of at least 30) and avoid sun exposure. After incubation, more treatment options become available to diminish the appearance of melasma. Dr. Green is a board-certified dermatologist with over 25 years of experience providing medical advice and treating some of the most discerning men and women from around the globe. In her discreet New York City dermatology office, she uses her expertise and experience to customize a treatment approach for each of her patients. Once you are ready to treat the melasma that developed during your pregnancy, Dr. Green is here to help.

How to treat Melasma on the face Naturally

Vitamin C is a powerful antioxidant skincare ingredient. Dr. Green’s MGSKINLABs has its own highly concentrated Vitamin C formulation, the Vita-C Serum, which is designed to promote skin cell renewal as well as collagen synthesis. The result is a decreased appearance of brown spots and an improvement in overall skin tone and texture. Dr. Green’s Vitamin C serum is the number one most popular topical skincare product in her office. Other skincare ingredients such as azelaic acid, kojic acid, and glycolic acid are available in a wide array of products (cleansers, serums, moisturizers, and toners) over-the-counter. They can also be beneficial in minimizing the appearance of melasma.

Will Melasma go away? How to get rid of melasma

Will melasma ever go away on its own? Or is it there to stay? The answer varies from patient to patient, depending largely on what triggered the onset of the melasma. For patients who experience melasma during pregnancy or as a result of taking oral birth control pills or other therapies that cause hormone changes, melasma may naturally subside either after pregnancy or once the hormonal medications have been stopped. However, for many patients, melasma is a skin condition that requires some type of cosmetic treatment option to improve the appearance of patches of hyperpigmentation on the skin. Melasma treatment is an investment, and since melasma is not permanently curable with any combination of skin care products and in-office treatment options, prevention is the best method for keeping melasma at bay. When you work with Dr. Green to treat your melasma, she will provide you with all of the pertinent aftercare information required for achieving and maintaining a clear, healthy, radiant complexion.

Melasma FAQs:

What is melasma on the face? How to get rid of melasma on the face

Melasma is a skin condition that most commonly affects areas of the face like the cheeks, nose, chin, upper lip, and forehead. Although less common, melasma can also affect areas of the body, such as the chest, neck, arms, and back. Sun exposure is one of the major contributing factors to the development of melasma, which is why areas of the body that might usually covered by clothing tend to be less affected. It is also the reason why many people notice their melasma seems to appear darker and more noticeable in the sunnier summer months. An expert in dermatology, like Dr. Michele Green in New York City, can get rid of melasma, whether it’s on the face or body, with various skincare products, topical prescriptions, and in-office treatment options. After melasma treatment, it is especially important to avoid sun exposure. The skin cells that are responsible for producing pigment, melanocytes, are triggered by UV exposure. If the treatment area is exposed to the sun after being treated, the melanocytes may be activated and cause the hyperpigmentation to return. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will work with you to develop a personalized melasma treatment plan and provide you with a particular aftercare protocol that will keep your complexion clear, bright, and radiant.

Is melasma hyperpigmentation?

Melasma is a type of hyperpigmentation characterized by patches of brown or grey-brown skin discoloration. Hyperpigmentation is a general term that refers to spots or patches of skin that are darker than one’s natural skin tone. In addition to melasma, there are several common types of hyperpigmentation, including sun spots, freckles, and post-inflammatory hyperpigmentation. Different types of hyperpigmentation can require unique treatment options to successfully reduce, which is why patients must consult an experienced board-certified dermatologist regarding a safe and effective cosmetic treatment plan. Dr. Green in NYC is a board-certified dermatologist with over two and a half decades of experience providing some of the world’s most discerning men and women with the best non-invasive cosmetic treatment options for hyperpigmentation and melasma. When you consult with Dr. Green, she will work with you to construct a personalized treatment plan that best suits your skin type, particular concerns, skin tone, and overall aesthetic goals.

Are freckles melasma?

Freckles are small, benign dark spots on the skin caused by an overproduction of melanin. Melanin is the pigmentation that gives color to the skin and hair, produced by skin cells called melanocytes. Freckles usually develop in areas of the body that are subject to the most sun exposure. Genetics and environment can influence whether one gets freckles. They’re most commonly found in those with light skin tones, who are more susceptible to sunburn and other forms of sun damage, which is why patients often see an increase in the prevalence of their freckles at the end of summer after significant sun exposure and why freckles will go away or fade considerably during winter months. The best way to prevent the appearance of freckles is to practice strict sun avoidance by staying inside when the sun is at its most intense and wearing sunscreen daily with a minimum of SPF 30. While melasma, like freckles, falls under the broad category of hyperpigmentation, they are separate skin conditions with unique characteristics. A board-certified dermatologist, such as Dr. Green in New York City, can physically assess your hyperpigmentation to identify and treat your skin condition appropriately.

Who gets melasma?

Some groups of people tend to be more affected by the appearance of melasma than others. The majority of those who struggle with the appearance of melasma are women. While there are men who may experience melasma, according to the American Academy of Dermatology, just 10% of individuals who develop this skin condition are men. Melasma is also more commonly found in those who have a light to medium brown skin tone (Fitzpatrick skin types III and IV) and darker skin tones (Fitzpatrick skin types V and VI) than those patients who have a fairer skin color. Patients with darker skin tones are more susceptible to melasma because there are more melanocytes present in brown skin, meaning that there is a greater potential for making a larger amount of melanin than there is in lighter skin. Additionally, those with a family history of melasma or facial hyperpigmentation are more likely to develop this skin condition. A family history of pigmentation or melasma indicates that there may be a genetic component involved in developing melasma.

Do men get melasma?

Yes! Melasma can affect individuals of any gender, age, or skin tone. However, it most commonly affects females between the ages of 20-40 with light brown to darker skin tones or who tan well. However, one in every ten individuals with melasma are men. While the exact cause of melasma remains unknown, there is thought to be a hormonal aspect to its development. Oral contraceptives, pregnancy, and natural hormonal changes in women are among the reasons that women are more commonly affected by melasma than men. While women get melasma at higher rates than men, men can still get melasma for the same reasons as women, including sun exposure, genetics, and hormones. Melasma in men can also be effectively reduced with the same cosmetic treatment options at Dr. Green’s private boutique dermatology office in Manhattan’s Upper East Side neighborhood. Dr. Green has over two and a half decades of experience treating some of the world’s most discerning men and women with the best cosmetic dermatology has to offer, including melasma treatments.

What triggers melasma?

Melasma occurs when skin cells called melanocytes are triggered to produce excess pigment, causing the appearance of dark patches of skin. Melanocytes have memory and are incredibly sensitive to UV exposure. Sun exposure, tanning beds, and other sources of UV light may trigger melanocytes to produce melanin. For this reason, it is important that individuals who are treated for melasma practice proper sun protection, including appropriate sunscreen use. Otherwise, patients may observe that the dark patches associated with their melasma return even after having successful treatment. Hormone changes have also been linked to melasma, and conditions that cause hormones to fluctuate, such as pregnancy, thyroid issues, and taking certain medications or oral contraceptives, may trigger its development. When you consult with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, she will recommend the treatments that are best suited to resolving your melasma and advise proper aftercare provisions so that you can maintain optimal results and best prevent a melasma flare.

Which hormone causes melasma? Does high estrogen cause melasma?

Research has demonstrated that elevated levels of estrogen are closely linked to the development of melasma. To a lesser degree, high levels of progesterone can be connected with melasma, too. Hormonal changes during pregnancy and menopause make women more susceptible to developing melasma than men, with 9 out of every 10 individuals affected by melasma being female. However, melasma can also be caused by a number of other contributing factors, including genetics, sun exposure, health conditions, and certain medications. When you consult with board-certified dermatologist Dr. Green at her private office in NYC’s Upper East Side neighborhood, she will collect a thorough medical and family history and physically assess your skin condition. Depending upon her evaluation, she may request certain laboratory tests be performed to evaluate for an underlying hormonal imbalance. She will then work with you to establish a personalized melasma treatment plan that caters to your specific needs and overall aesthetic goals to provide a long-lasting, clear, and radiant complexion.

Can an IUD cause melasma?

A hormonal IUD may trigger the development of melasma. Any form of birth control that causes hormone changes may stimulate melanocytes in the skin to produce melanin, including oral contraceptives, birth control patches, NuvaRing, Depo-Provera injections, and an IUD. Non-hormonal and barrier forms of birth control are available that are less likely to cause melasma, which may be recommended for individuals who are susceptible to or have a history of melasma.

Do I have melasma?

The best way to determine if you have melasma is to have a consultation with an expert in the field of dermatology, such as Dr. Michele Green in New York City. Dr. Green is an internationally renowned board-certified dermatologist with over two and a half decades of experience providing her patients from around the globe with the best non-invasive treatment options available, including for melasma. An experienced dermatologist can typically diagnose your melasma upon physical examination, observing the distribution and characteristics of the skin discoloration. In addition to diagnosing your hyperpigmentation, Dr. Green can recommend a personalized combination of in-office treatment options and specially formulated skincare products that are best suited to your unique skin concerns and overall aesthetic goals.

How to get rid of melasma mustache

The term “melasma mustache” refers specifically to hyperpigmentation of the upper lip. The same underlying factors that contribute to melasma on the rest of the face are responsible for the development of melasma on the upper lip. UV exposure, in addition to a combination of hormone and genetic elements, triggers melanocytes in the skin. The melanocytes become hyperactive and produce an excess of melanin, the component in the skin that is responsible for pigment. In the case of the “melasma mustache,” the hyperpigmentation is exacerbated on the upper lip. Dr. Michele Green in New York City is able to diminish the appearance of upper lip melasma utilizing the same treatment methods as for the rest of the face. Dr. Green loves the results that the Cosmelan peel treatment provides her patients who are struggling with melasma and often suggests a Cosmelan therapy to anyone who is dealing with stubborn hyperpigmentation in the upper lip area. In addition, using skin-lightening products, either with or without hydroquinone and light chemical peels, can hasten the removal of stubborn upper lip hyperpigmentation. If you are struggling with hyperpigmentation of the upper lip and want to discover a way to eliminate the appearance of the dreaded melasma mustache, schedule a consultation with Dr. Green.

Does melasma itch?

No. Although melasma is visibly noticeable, it is a skin condition of pigmentation that does not generally cause any itching, discomfort, or pain. A patient with melasma will not notice any changes in the texture or the feeling of their skin due to this skin condition. Patients who are experiencing itchy, irritated skin should also consult with a board-certified dermatologist in order to understand the state of their skin and develop a plan for getting healthy skin that is free from irritation.

Can melasma be red?

Melasma is a skin condition that causes discolored patches of skin that are darker in color than the surrounding skin. The patches of darker skin are usually light brown, grey-brown, or bluish-grey. Sometimes, the skin in the affected area can become inflamed, causing it to appear reddish. Some topical and oral treatments for melasma may also result in skin appearing red by causing inflammation or irritation. If redness or other signs of skin irritation, such as itching, burning, peeling, stinging, or pain, develop after starting a new melasma treatment option, alert the prescribing dermatologist so that any necessary adjustments to your treatment plan can be made. Continuing to use certain melasma treatments while the skin is irritated can result in worsening hyperpigmentation or even permanent skin damage.

Can hydroquinone make melasma worse?

Hydroquinone is a topical treatment that is often prescribed to reduce the appearance of melasma and hyperpigmentation. The skin-brightening effects of hydroquinone are due to the fact that it interferes with the action of melanocytes, which are the skin cells responsible for producing melanin or pigment. Hydroquinone is not available over the counter and must be prescribed by a dermatologist. It can be used safely on a daily basis for up to six months, and its use must also be monitored by a dermatologist who can make adjustments to the prescription if necessary. If used excessively or incorrectly, hydroquinone can worsen the overall skin condition and the appearance of melasma.

Hydroquinone also increases the skin’s sensitivity to the sun, meaning strict sun avoidance is essential while using the topical. Sun exposure in an area being treated with hydroquinone can result in worsening hyperpigmentation and UV damage. Patients should also avoid sun lamps, tanning booths, and other forms of UV exposure while using hydroquinone to protect their skin. While rare, an allergic reaction to hydroquinone may also result in skin darkening. There is another rare occurrence, a paradoxical reaction called exogenous ochronosis, whereby prolonged use of hydroquinone results in darker skin. It is critical to work with an experienced board-certified dermatologist, such as Dr. Michele Green in NYC, to ensure safety, efficacy, and optimal results in regard to hydroquinone.

How to cover melasma with makeup

Visible skin problems such as melasma can seriously affect one’s overall quality of life and make one feel self-conscious about their appearance. Dr. Michele Green is an internationally renowned cosmetic dermatologist with more than two decades of experience customizing the treatment plans of her patients, helping them to look and feel like the very best versions of themselves. In her New York City office, you will have the opportunity to discuss with her the most appropriate and effective in-office treatments and specially formulated skincare products to diminish the appearance of your melasma. However, in the meantime, it can even be a challenge to just cover the hyperpigmented skin with makeup! In order to cover up melasma, there are a few tips to keep in mind.

Please moisturize your skin before you apply any sunscreen or makeup to the face. By moisturizing, you are not only helping to nourish and protect your skin but also creating a strong foundation for makeup application to hide visible melasma. Then, apply your chemical and physical sunscreens to guarantee the best sun protection. Next, use a facial primer before applying any foundation or concealer. A primer is a product that helps makeup last longer and creates a smooth, silky look. Dr. Green recommends choosing a full-coverage foundation and concealer to cover the appearance of visible melasma best, then setting the liquid makeup with a translucent powder. These steps can become tedious when trying to cover melasma on a daily basis. In order to take care of your melasma once and for all and feel confident going makeup-free, schedule a consultation with Dr. Green.

What is the fastest way to cure melasma?

While there is no cure, the fastest way to improve the appearance of melasma is to consult an experienced board-certified dermatologist, such as Dr. Green in NYC. Dr. Green has over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive treatment options, including for hyperpigmentation. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will work with you to create a customized treatment plan that’s best suited to your personal needs and aesthetic goals.

Will melasma fade on its own?

Depending on the cause of melasma, it can sometimes fade on its own. Typically, melasma will fade once you stay completely out of the sun. However, many cases require cosmetic intervention, whether that be a customized regimen of specially formulated skincare products, a series of in-office treatments, or some combination of both. Melasma is a complex skin condition that a variety of factors, including genetics, hormone changes, and sun exposure, can influence. Additionally, melasma can affect pregnant women due to the hormonal changes occurring throughout the pregnancy. In that case, it may resolve on its own once the pregnancy is complete and hormones have stabilized, provided complete sun protection is adhered to.

Another instance where this may occur is when melasma develops due to hormonal birth control. If melasma is caused by hormonal birth control, then its appearance may diminish once the individual ceases using the prescription. In most other cases, patients require a targeted treatment plan to reduce the appearance of their melasma successfully. An experienced board-certified dermatologist, such as Dr. Green in NYC, can work with you to create a personalized melasma treatment plan that suits your skin type, needs, and aesthetic goals.

How do I Get Started with treating Melasma today?

Melasma can be a difficult skin condition to reduce and manage, especially when relying solely on over-the-counter skincare products that target dark spots. The most effective and efficient way to treat melasma is with a board-certified cosmetic dermatologist, like Dr. Green in NYC, who can develop a personalized treatment protocol for you based on your specific concerns and recommend the best combination of in-office treatments and at-home topical skincare products to resolve your hyperpigmentation. Whether you are struggling with melasma, post-inflammatory hyperpigmentation, sun spots, sun damage, or another form of hyperpigmentation, Dr. Green is here to help.

Dr. Green is an internationally renowned board-certified cosmetic dermatologist with over 25 years of experience providing some of the world’s most discerning individuals with the best treatment options, including reducing hyperpigmentation and melasma. She takes a holistic approach and embraces a less-is-more philosophy regarding facial rejuvenation, customizing each patient’s treatment plan to meet their particular needs and aesthetic goals. Dr. Green is consistently identified as one of NYC’s best dermatologists by the New York Times, New York Magazine, Super Doctors, and Castle Connolly for her dedication to her patients and expertise. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side, she will work with you to create a unique treatment plan that provides you with a clear, radiant complexion that lasts. To schedule a consultation with Dr. Green and get started with treating your melasma, sun damage, or facial or bodily hyperpigmentation, please get in touch with us online today or call our New York City-based dermatology office at 212-535-3088.