What Causes Melasma?

Melasma is a skin condition that causes patches of skin discoloration and dark spots on the face and elsewhere on the body for various reasons, including sun exposure, genetics, and hormonal changes. For many patients, developing this kind of pigmentation of the skin can be cause for concern, as it may be mistaken for another skin condition. Whether pigmentation is triggered by too much sun exposure or other causes, it’s important to carefully observe dark spots or brown patches on the skin to ensure that there is no risk of melanoma or skin cancer. Additionally, even when pigmentation is not a sign of something more ominous, irregularities in skin tone can make patients feel self-conscious about how their skin has changed. Dr. Michele Green is a cosmetic dermatologist with over 25 years of experience in diagnosing and treating melasma in her private NYC dermatology office. She can help you find the best combination of in-office treatment options and specially formulated skincare products to get your complexion looking better than it ever has.

Melasma is a common skin disorder that leads to brown or gray-brown patches on the surface of the skin. Melasma is linked to an overproduction of melanin in concentrated cells on the skin via melanocytes (melanin-producing cells). This skin condition can be exacerbated or triggered by a variety of causes and is more common among women than men. According to the American Academy of Dermatology, 90 percent of melasma occurs in women. Regardless of gender and skin type, patients with melasma often feel self-conscious about these concentrated pigment patches. Thankfully, there are a variety of in-office treatment options available at Dr. Green’s private dermatology office in NYC that can help reduce the appearance of melasma, including chemical peels, topical treatments, and Cosmelan peels.

Dr. Green 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 available, including those for melasma. She takes a holistic approach to skin rejuvenation, customizing each patient’s treatment plan to incorporate a combination of in-office treatment options and specially formulated skincare products that are best suited to their particular skin condition, concerns, and aesthetic goals. Dr. Green is an expert in treating melasma and other forms of pigmentation that result from countless potential triggers. Whether the melasma is a result of the mask of pregnancy, laser treatments, or ultraviolet light in combination with birth control pills, Dr. Green has been successful at treating these forms of hyperpigmentation. She is consistently identified as one of NYC’s best dermatologists by Super Doctors, Castle Connolly, New York Magazine, and the New York Times for her dedication to her patients and expertise.

What is melasma?

Melasma is a common, benign skin condition that causes dark patches of skin discoloration on the face and chest. Melasma predominately affects the upper lip, the bridge of the nose, the forehead, and the cheeks and is often symmetrical on both sides of the face. Melasma (chloasma) is also called the mask of pregnancy, as it affects between 15-50% of pregnant women. In general, 1.5-33% of the general population have melasma, and it’s most common among women between the ages of 20 and 40.

Melasma typically appears on the face but may also appear on areas of the forearms, neck, and shoulders. In general, when it appears on other parts of the body, it is in areas that have had excessive sun exposure. Patients with darker skin, such as those of Latin/Hispanic, African, Mediterranean, or Middle Eastern descent, are statistically much more likely to suffer from melasma. Patients with lighter skin tones may develop melasma, but it is often much less noticeable than patients with darker skin types and skin tones, especially in patients who have brown skin. This is due to the fact that there is a higher concentration of melanocytes in darker skin. Melanocytes are the skin cells that are responsible for making melanin, the pigment in the skin that gives it color. When various contributing factors trigger melanocytes, they create excess pigment that can result in melasma.

Though melasma is not a harmful skin condition and does not necessarily put a patient at greater risk for developing skin cancer, this form of pigmentation can make patients feel self-conscious about their skin tone, significantly decreasing a patient’s quality of life. There are a variety of treatment options that can be used to reduce the appearance of melasma on the surface of the skin. Other treatment options have the potential to exacerbate melasma among darker skin types inadvertently, worsening the appearance of the skin discoloration. For this reason, it’s important to have your skin condition carefully examined by a board-certified healthcare professional who specializes in dermatology before engaging with any skin resurfacing treatment options, such as laser treatments or deep chemical peels. If you are unsure as to whether or not an area of hyperpigmentation is melasma or related to another skin condition, it’s best to schedule a consultation with an experienced board-certified dermatologist, like Dr. Michele Green in New York, who can recommend the best treatment no matter what your hyperpigmentation is caused by.

What is melasma caused by?

Though melasma is typically a skin condition that develops gradually due to the excess melanin production by melanocytes that rely on the epidermis, melasma can cause pigmentation in multiple layers of the dermis. There are three main types of melasma: epidermal melasma, dermal melasma, and mixed melasma. In cases of epidermal melasma, the pigmentation occurs in the top layer of the skin (along the skin’s surface), creating dark brown patches of skin that have a well-defined border. With dermal melasma, the pigmentation has a light brown or blue-gray skin color surrounded by a blurry border and is more difficult to treat as it affects the dermal or middle layer of the skin. The most common form is mixed melasma, which includes bluish and brown patches of discoloration (essentially a combination of both epidermal and dermal melasma).

How can you diagnose melasma?

Melasma is typically diagnosed via a visual exam of the affected area or the area where the pigmentation or skin discoloration is present. Dr. Green has a vast number of patients with melasma and is incredibly knowledgeable about this skin condition. For many patients, a visual exam is all that’s needed to diagnose this specific skin discoloration patterning.

Wood’s lamp is an older diagnostic tool for melasma that involves using a specialized light to examine several dermal layers. Through this method, Dr. Green can observe the depth of the affected area of the skin, as well as check for bacterial or fungal infections. In certain cases, it may be prudent to do a biopsy of the affected area. Skin conditions that are commonly confused for melasma include lichen planus and lentigo (age spots), among others. The biopsy will involve removing a small piece of the discolored skin for testing to rule out any more harmful skin conditions. The results of the test will also reveal the severity of the melasma in terms of how deep and widespread it is.

Cosmelan treatment for Melasma – before and after

What are the causes of Melasma?

The exact causes of melasma remain unknown. In general, melasma is caused by an increase in melanin produced by overactive melanocytes in the skin. It is not known why these melanocytes are stimulated to produce an overproduction of melanin, resulting in areas of concentrated pigment. However, certain risk factors are known to exacerbate melasma.

• Sun exposure: The most common trigger in producing melasma is direct exposure to the sun.  Ultraviolet light, UVA, and UVB rays from the sun stimulate the melanocytes to produce more melanin. It is so important to use sunscreen daily, with an SPF of 50 or higher. It is 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.
• Tanning Beds: Just like direct sunlight, tanning beds emit harmful UV rays and visible light that can stimulate melanocytes to produce melanin, exacerbate the appearance of skin discoloration, and increase a patient’s risk for skin cancer.
• Hormones:  It has been found that the use of birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy can all cause melasma to flare. In fact, about 25% of women who take birth control pills develop melasma. This is also why melasma is often referred to as the mask of pregnancy due to an 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.
• Skincare products: Certain over-the-counter skincare products can worsen the appearance of melasma. This is particularly common for harsh exfoliants and other products that can increase photosensitivity. Additionally, scented soaps are linked to the worsening of melasma.
• Oral Medications: Certain oral antibiotics, cardiac medications, and other photosensitizing medications can trigger melasma or exacerbate its severity. These medications include nonsteroidal anti-inflammatory drugs, antipsychotics, and anti-seizure medications.
• Thyroid Disease: Currently, it is thought that thyroid disease may be a cause of melasma in some patients, as many patients with thyroid disease are diagnosed with melasma. Thyroid disorders can impact the immune system, which can lead to inflammation that triggers melanocytes to produce more melanin.
• Genetics: Between one-third and one-half of melasma patients have a family history of melasma. Additionally, identical twins commonly share symptoms of melasma. Patients whose close relatives have melasma have a genetic predisposition to suffer from melasma and are more likely to develop it themselves, which is why it is thought to have a genetic component.
• Skin Tone: Individuals with darker skin tones or who easily tan are more likely to develop melasma. This is because darker skin naturally has a higher concentration of melanocytes than lighter skin. As a result, patients with darker skin tones are more prone to melasma as a result of sun exposure and excess melanin production.
• Laser Treatments: Often, patients have laser treatments to try and remove melasma, only to result in worsening its appearance. Melasma can be even more difficult to remove after a laser treatment because the laser can cause hyperpigmentation to become further entrenched in the deeper layers of the skin. Dr. Green prefers to treat melasma with Mesopeels, Chemical peels, and Cosmelan peels to prevent exacerbating the existing hyperpigmentation.

What causes melasma in males?

Melasma is an incredibly common skin condition. However, melasma tends to affect women more than men. In fact, just 10 percent of all melasma patients are male. However, there are a variety of environmental and biological risk factors that can lead to melasma occurring in male patients. These risk factors include too much sun exposure over time, hormonal changes, genetics, irritating skincare products, photosensitizing medications, thyroid disorders, parasitic infestations, and stress, among others. In general, the process for the treatment of melasma in male patients is quite similar to that of female patients. A combination of topical treatment options and in-office procedures, such as chemical peels, Cosmelan peels, or Microneedling procedures, can successfully reduce the appearance of melasma in male patients. Although men don’t develop melasma at the same rate as women, Dr. Green treats men and women with melasma at her private, boutique dermatology office in Manhattan’s Upper East Side neighborhood with personalized treatment plans.

What causes melasma on the face?

While the patchy skin discoloration and dark spots associated with melasma can affect any area of the body, melasma most commonly affects the face. Melasma on the face can occur as a result of many risk factors, from sun exposure to tanning beds to hormonal changes and genetics. The main culprit for the development of melasma is the overproduction of melanin by the melanocytes, which causes the development of hyperpigmentation. The melanocytes are the skin cells that are responsible for producing melanin. Melanin is the name for the pigment that gives the skin color. In melasma, when melanocytes produce too much melanin, the areas with excess pigment appear as dark patches that have more pigmentation than the rest of the surrounding skin. Melasma on the face and elsewhere on the body are similarly treated using topical creams as well as certain peels that stop melanin overproduction and fade the appearance of hyperpigmentation. When you consult with board-certified dermatologist Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will work with you to develop a personalized treatment plan for your facial melasma that is designed to help you achieve and maintain a clear, radiant complexion and an even skin tone that lasts.

What causes a melasma mustache? What causes melasma on the upper lip?

In many cases of melasma, a patient will notice that the skin discoloration characteristic of this skin condition appears above the upper lip. This particular form of melasma is commonly referred to as a melasma mustache. Typically, the causes of a melasma mustache are like any other case of melasma and could be due to various factors, including sun exposure, hormonal shifts, genetics, thyroid disease, or certain medications. Additionally, patients who live in high altitudes may be more likely to develop melasma, though research on this particular relationship is ongoing. A melasma mustache can be treated with the same topical and in-office treatments as most standard melasma patches, which can offer relief to many patients who experience this unwanted pigmentation.

45-54 year old woman, Cosmelan treatment before and after

What causes melasma during pregnancy? When does melasma occur in pregnancy?

For many pregnant women, the development of melasma can be a frustrating part of pregnancy. Though it’s not entirely clear why melasma is so commonly linked to pregnancy, current research suggests that increased hormones in the body can lead to the development of melasma. These hormones include increased estrogen, progesterone, and melanocyte-stimulating hormones during a pregnant patient’s third trimester. However, thankfully for most patients, pregnancy-induced melasma does tend to dissipate naturally after the pregnancy has concluded and the body’s hormones return to normal levels. Additionally, if you’re suffering from melasma during pregnancy, there are safe and effective topical treatments, such as vitamin C, that can be used to minimize the pigmented areas on the skin. If you notice that the melasma remains after three to six months post-partum, it may indicate that you will require cosmetic treatments to get rid of it.

What triggers melasma? What are the risk factors for Melasma?

Many factors may trigger melasma. The two main triggers are UV radiation and hormones. UV radiation from sun exposure and tanning beds can trigger the melanocytes to produce more melanin. When melanocytes are stimulated at different rates, there may be concentrated melanin in certain areas of your face and not others that will eventually appear as melasma on your face. This is the main reason why most individuals notice that their melasma symptoms worsen during the summer months. In terms of hormones, higher levels of estrogen in the body will similarly trigger melanocytes of the skin to produce more pigment. This is the main reason why pregnant women and women on hormonal birth control are at higher risk of getting melasma.

Other possible risk factors for triggering melasma development can include some anti-seizure medications, hypothyroidism, certain phototoxic drugs, and skincare products. If you notice changes in your skin shortly after introducing a new product or medication into your body, it could be a good indication that that is what is triggering your melasma. By figuring out your triggers and practicing sun protection, you can prevent your melasma from worsening or recurring.

What hormones cause melasma? Which hormonal imbalance causes melasma?

If you’re curious about what hormonal changes cause melasma, it’s important to consider which particular hormones are linked with the development of melasma. In general, hormones that are commonly used in oral birth control (such as estrogen, progesterone, and synthetic versions of these hormones) are linked to the development of melasma in many patients. As progesterone is a naturally occurring hormone that vastly increases during pregnancy, it has been greatly linked to pregnancy-induced melasma or the “mask of pregnancy.” Postmenopausal women are sometimes given progesterone, and melasma development has been noticed. In general, any melanocyte-stimulating hormone could lead to the development of melasma.

Research has also shown that there is a strong association between hypothyroidism and melasma. Although the exact mechanism through which one can impact the other is yet to be established, it is believed that hormonal changes that occur with thyroid disease trigger melasma. In addition, individuals with hypothyroidism tend to have pale skin due to dermal water content and dermal mucopolysaccharides, which can make any melasma appear more prominent.

Does estrogen cause melasma?

Estrogen is one of the most common and well-known melasma triggers, even though the exact mechanism is not fully understood. It is believed that estrogen acts on melanocytes and increases the number of melanin receptors in the skin, making melanocytes more sensitive to the sun and inflammation. About 25 percent of women who take hormonal birth control that contains estrogen will develop melasma, and about 90 percent of women will experience a worsening of melasma during pregnancy. If you have noticed melasma development after taking hormonal birth control, you can try changing your birth control or refrain from taking it to see if there is any improvement. Hormonal causes of melasma can potentially go away once your hormones stabilize. If the melasma remains more than three to six months after ceasing hormonal birth control or post-partum, the melasma may be permanent and may require cosmetic procedures to remove.

Does progesterone cause melasma?

Progesterone is another hormone that can contribute to the presence of melasma. Progesterone is a well-known and common trigger of melasma, as increased levels of progesterone have been shown to increase the chances of developing melasma. Increased levels of progesterone in the body can be caused by a number of different factors, including taking hormonal birth control pills, pregnancy, or progesterone treatments for menopause. If you are experiencing new or worsening melasma as a result of hormone fluctuations, consult with Dr. Green to determine the best solution for regulating progesterone levels and combatting melasma.

Can tretinoin cause melasma?

Tretinoin is a common ingredient in medication used to treat melasma, and, as such, it works to combat melasma rather than cause it. Tretinoin is a topical retinoid found in such medications as Retin-A and helps to increase skin cell turnover to fight hyperpigmentation. When applied to the treatment area, topical medication containing tretinoin triggers the production of new skin cells to replace the melasma-pigmented skin. When you have your initial consultation with Dr. Green, she can help determine if tretinoin is the right solution to combat your melasma.

Does birth control cause melasma?

Birth control pills may not be the sole factor behind the development of melasma. Still, there is a strong correlation between hormonal changes and the development of melasma on the surface of the skin. Many hormonal birth control pills work by increasing the levels of estrogen in the body, which can increase pigment production, leading to melasma. For this reason, when patients develop melasma, Dr. Green will encourage them to discontinue the use of any birth control pills or hormone therapies, if possible. In some patients, the simple discontinuation of oral contraceptives can cause the melasma to subside.

Can menopause cause melasma? Will melasma go away after menopause?

The onset of menopause leads to hormone fluctuations and changes in the body. In order to mitigate the side effects of menopause, including hot flashes and excessive sweating at night, menopausal women may be prescribed progesterone and estrogen. The intake of these hormones can work to alleviate these symptoms. However, increased levels of progesterone and estrogen can be a risk factor for the development of melasma. If melasma develops as a result of progesterone treatment during menopause, it may be best to consult with Dr. Green to find another way to reduce symptoms of menopause. Unlike melasma that develops during pregnancy, melasma may not go away on its own after menopause. Melasma that remains after menopause usually requires treatment by an experienced board-certified dermatologist, such as Dr. Green.

Can stress cause melasma?

Sustained amounts of stress can wreak havoc on the systems in the body. When you are stressed, your body releases higher amounts of the hormone called cortisol, which leads to a hormonal imbalance. As a result, the body can produce an increased amount of estrogen to try to balance out, which creates an estrogen-rich environment, putting you at risk for the development of melasma. The full effect of stress on the onset of melasma has not been extensively studied by researchers at this time. Therefore, the relationship between stress and melasma has yet to be fully determined.

Which vitamin deficiency causes melasma?

Though different nutritional deficiencies are not indicated as a cause of melasma, some scientific evidence has suggested that deficiencies in iron, vitamin D, and vitamin B12 are linked to the development of melasma. For this reason, your healthcare provider may inquire about your dietary habits to determine if any vitamin deficiencies may be an underlying factor in the development of pigmentation. Additionally, to help support healthy skin, it’s always good to prioritize foods that are rich in Vitamin D. These foods include meat, dairy milk, almond milk, eggs, mushrooms, orange juice, yogurt, and mushrooms. Lastly, certain vitamins are linked with helping to restore pigmented skin after melasma has developed. Vitamin C serums, vitamin K creams, and retinoids (Vitamin-A derived) can all be used to help improve skin tone and texture, as well as lighten the brown patches associated with melasma.

Can hypothyroidism cause melasma?

Recent studies have indicated that thyroid disease, classified by two thyroid disorders known as hypothyroidism and hyperthyroidism, may be linked to the development of melasma. Hypothyroidism, a disorder that causes an underactive thyroid, prevents the body from receiving a standard level of hormones from the thyroid, which in turn can cause issues of hormonal balance and thus may lead to the development of melasma on the skin. Additionally, hyperthyroidism, a disorder that causes an overactive thyroid, also seems to affect the development of melasma. Though the exact melasma-causing mechanism is not clear, it seems that these hormones can change the production of inflammatory cytokines in the body, thus leading to pigmentation on the surface of the skin. For this reason, if you are diagnosed with melasma, you may also be tested for thyroid disorders to determine if an imbalance in thyroid-producing hormones is behind the discoloration.

What medication causes melasma?

Certain medications have been shown to put patients at greater risk for developing melasma. One such type of medication is anti-seizure medications such as Clobazam and Phenytoin. If you are experiencing the onset of melasma while taking these medications, dermatologists recommend finding an alternate treatment method in order to halt the development of melasma. Birth control pills that contain estrogen and progesterone have also been shown to put patients at risk of developing melasma. If hormonal birth control methods lead to melasma in patients, Dr. Green recommends seeking a non-hormonal form of birth control. Some medications increase skin photosensitivity, which is another risk factor for the development of melasma – increased exposure to UV rays. Medications that increase sensitivity to sunlight include certain antibiotics, blood pressure medications, and retinoids. Be sure to consult with Dr. Green and your primary care provider before making any changes to your medications.

Does spironolactone cause melasma?

Spironolactone is a type of medication that is commonly used to help treat acne and hair loss or manage other symptoms of a medical condition called polycystic ovarian syndrome (PCOS). Spironolactone regulates hormonal changes that could potentially contribute to the development of skin conditions like acne. The oral treatment works by suppressing a type of hormone in the body known as androgens. The suppression of these androgens, such as testosterone, helps to prevent acne formation. However, when androgens are blocked, spironolactone creates an estrogen-rich environment in the body. High levels or fluctuations of estrogen have been shown to be a risk factor for the development of melasma, and, as such, it is possible that spironolactone can cause or worsen melasma. However, at this time, more research needs to be done to determine if spironolactone truly leads to the development of melasma.

What is the best prevention and treatment of melasma in NYC?

One of the best treatment options for melasma and other forms of hyperpigmentation is prevention, which typically comes down to avoiding excess sun exposure and discontinuing the use of medications and skin care products that may be causing melasma. To prevent pigmentation on the skin, including not only melasma but also age spots, sun spots, and hyperpigmentation, Dr. Green always recommends wearing a daily broad-spectrum sunscreen with an SPF of 50 or higher. The best way to prevent unwanted pigmentation, signs of aging, or the risk of skin cancer is to protect the skin from harmful UV rays.

For patients who have unwanted melasma or pigmentation on the skin, the best treatment available is a combination of topical treatments and in-office procedures, such as Cosmelan peels. A custom treatment plan that combines routine skincare with non-invasive in-office treatments can help to reduce the appearance of melasma and prevent further pigmentation. Additionally, some oral medications, including tranexamic acid (typically used to treat women with heavy or painful menstrual cycles), are currently being studied for their effectiveness in treating melasma. When you work with Dr. Green, she’ll be able to carefully assess your medical history, current skin condition, and individual needs and goals to develop a comprehensive treatment plan that’s best for you.

Cosmelan – 10 weeks before and after

Which sunscreen should patients with melasma use?

When choosing sunscreen for patients with melasma, it is best to use an SPF of 50 or higher.  In addition, Dr. Green recommends a combination of a chemical and a physical sunblock.  Melasma patients are much more sensitive to the sun and layering both types of sunscreens can provide you with the best possible sun protection.  Physical sunscreen, also called mineral sunscreen, creates a physical barrier on the skin which filters out and defends from the damaging UV rays. Physical sunblocks generally contain titanium dioxide or zinc oxide.

Chemical sunscreens absorb and scatter UV rays, are generally water-resistant, and are less likely to leave a white residue behind.  Common active ingredients used in chemical sunblocks are oxybenzone, azobenzene, octinoxate, and octisalate, among others. When choosing a sunscreen formulation, it is always wise to choose one that is non-comedogenic, oil-free, paraben-free, and fragrance-free.

During and after melasma treatment, it is very important to limit sun exposure. Try to wear a broad-brimmed hat and protective clothing when outside, and discontinue hormonal medication use when possible. It is essential to reapply sunscreen every two hours, and even more frequently if you go swimming or do any rigorous exercise that involves excessive sweating.

Does melasma ever go away?

Yes, melasma does go away with the proper treatments. For some individuals, melasma will go away on its own depending on what the triggers are. Melasma that is a result of hormones due to hormonal oral contraceptives or pregnancy may fade on its own within a few months after birth. Other treatments like the Cosmelan peel can greatly reduce melasma and restore clear, even skin tone. However, a reoccurrence is always possible if you do not maintain the proper skincare routine and if you fail to apply sunscreen with an SPF of 30 and above on a daily basis. Additional studies that have been done by A.G. Pandya and colleagues have indicated that oral tranexamc acid is another beneficial treatment that can be used to significantly lighten the appearance of melasma. Dr. Green can advise which combination of treatments, supplements, and topicals will be the best to get rid of your melasma once and for all.

Which procedures should I avoid with melasma?

It is extremely important to avoid the majority of laser treatments, such as the IPL, Fraxel, or Picosure laser in treating facial melasma as these can result in post-inflammatory hyperpigmentation. Dr. Michele Green has years of experience in treating melasma and feels that the most difficult cases of melasma to treat are those which have undergone these laser treatments. These lasers seem to “burn the pigmentation” into the skin and make it much more difficult to remove this hyperpigmentation. There are only a few laser treatments that are gentle enough to treat melasma, such as the Clear + Brilliant and V-Beam lasers.

If you are being treated for melasma, it’s best to start with non-invasive techniques, such as the Cosmelan peel, mesopeels, microneedling, HydraFacials, or microdermabrasion. Additionally, it’s important to treat melasma under the careful supervision of a board-certified dermatologist, like Dr. Michele Green. Dr. Green often encounters patients who have attempted to treat pigmentation at medical or aesthetic spas and, in many cases, these attempted treatments can make the appearance of melasma much worse. Dr. Green understands the importance of accurately diagnosing and treating pigmentation the first time around, and the safety and satisfaction of her patients is her top priority. It is also important to note that you should not treat melasma while you are pregnant or nursing.

Topical skincare for melasma

There are both over-the-counter skincare products and prescription topicals that treat the hyperpigmentation caused by melasma. The following are some of the key ingredients available used to fight melasma:

• Kojic acid is derived from fungi. Its primary use is skin lightening, though it also has some antimicrobial effects. Kojic acid is often compounded with other ingredients to fight hyperpigmentation and melasma.
• Retinoids and Retin-A are vitamin A-derived products that work by increasing skin cell turnover and aid in treating acne as well as hyperpigmentation and melasma. Retinoids are popular to use for a variety of skin texture and discoloration issues, including melasma, sun spots, fine lines and wrinkles, and acne. There are different strengths of retinoids, and the appropriate concentration depends on your skin’s sensitivity. It is best to start with the lowest dosage and to increase gradually as long as your skin can tolerate it.
• Azelaic acid is derived from grains and brightens pigmentation. It is useful for the treatment of rosacea, melasma, and other skin disorders.
• Hydroquinone is a bleaching agent that lightens hyperpigmentation and melasma. Over-the-counter products containing hydroquinones are no longer available. Hydroquinones of 4 percent or greater are available by prescription only through a qualified dermatologist, like Dr. Michele Green in NYC.
• Vitamin C serum is a powerful antioxidant that acts by decreasing redness and pigmentation without irritation. Dr. Green’s MGSKINLABS has developed its vitamin C formulation, Vita-C Serum, which is designed to promote cell renewal and collagen synthesis to reduce the appearance of brown spots and improve skin texture.
• Cosmelan is an amazing product formulated with high-strength hydroquinone and retinoids to treat melasma and overall skin pigmentation.
• Vitamin K cream treats a wide variety of skin conditions, including broken capillaries, bruising, hyperpigmentation, and skin irritation.
• Glycolic Acid is the smallest alpha-hydroxy acid and is effective at removing the outermost layer of dead cells from your skin, treating skin discoloration, hyperpigmentation, fine lines and wrinkles, and acne scars.
• Corticosteroids and tretinoin are two topical treatment options that are available in lotions, gels, and creams. Corticosteroids can only be safely used for a short time in combination treatment, as topical steroid creams can thin the skin. Tretinoin creams, like Retin-A, are effective at lightening dark patches on the skin, including pigmentation from melasma.

Which cosmetic treatment options are best to remove melasma?

For many patients, in-office treatment options are the best method to reduce the appearance of melasma on the skin effectively. Dr. Green offers a variety of non-invasive treatment options that can work to reduce issues of hyperpigmentation and discoloration on the skin, including melasma, at her private, boutique dermatology office in Manhattan’s Upper East Side neighborhood, including:

• Cosmelan Peels are Dr. Michele Green’s gold standard for treating hyperpigmentation and melasma. The Cosmelan peel is a professional-grade mask that has 51 active ingredients that actively work to depigment your skin. These ingredients contain key tyrosinase inhibitors, which block the production of melanin in the skin, and other lightening agents to restore beautiful, clear skin. It can treat a variety of conditions, from melasma, age spots, blemishes, and skin discoloration, among others. The Cosmelan peel is a series of two peels, three weeks apart, that are applied to your skin for several hours based on your skin type and the extent of your hyperpigmentation/melasma. Generally, the darker your skin tone, the longer the peel needs to be left on your skin. In between and after peels, you will need to use specially formulated creams to reduce hyperpigmentation/melasma, such as hydroquinone, vitamin K cream, sunscreen, and Cosmelan 2. Patients have seen great results from the Cosmelan peel, and for many, Cosmelan is the only thing that has worked for melasma. If you have tried other treatment options without improvement, give Cosmelan a try.
• Chemical Peels are an excellent way to rejuvenate the skin by helping to exfoliate the outer layers of skin, the epidermis.  A chemical solution of glycolic acid or trichloroacetic acid is applied to the skin to remove the top layers.  Dr. Green utilizes chemical peels in conjunction with hydroquinones and tretinoin to exfoliate the skin and provide the best result from your chemical peel. There are different strengths of chemical peels, and Dr. Green will customize your protocol based on your skin type and the degree of pigmentation. Patients with darker skin tones should not tolerate more than a medium-strength peel to avoid other potential side effects, such as hypopigmentation. Chemical peels can treat acne scars, fine lines and wrinkles, hyperpigmentation, and melasma. Side effects of chemical peels are dryness and peeling and some irritation, which can last for several days.  Lotion and hydrating moisturizers should be used after the chemical peel, along with sun protection of an SPF of 30 or greater.
• Microdermabrasion is a treatment option that mechanically exfoliates and removes the superficial layer of dead skin cells with a handheld device. Microdermabrasion sprays aluminum oxide or sodium bicarbonate crystals with a vacuum and suction to exfoliate the stratum corneum or top layer of the skin. In addition to melasma, microdermabrasion treats fine lines, wrinkles, enlarged pores, sun damage, blackheads, acne, and acne scars and evens out skin tone and texture.
• HydraFacial is a three-step, 30-minute procedure that involves deep cleaning, gentle exfoliating, and extracting impurities from your skin.  After your skin is cleansed and exfoliated, serums are infused into your pores with the HydraPeel tip.  Dr. Green utilizes skin boosters designed for HydraFacial®, such as Britenol ®, which brightens the skin and minimizes hyperpigmentation.
• Microneedling with Melanostop tran3x is an in-office treatment that combines traditional micro-needling with a depigmenting serum to brighten patches of melasma. Microneedling, also known as collagen induction therapy, uses micro-needles to prick the surface of the skin. This process not only activates the body’s natural wound-healing properties to smooth over rough skin texture but also creates micro-channels in the skin that can absorb nourishing gels and serums. When Microneedling is combined with Melanostop tran3x treatment, the affected area is treated deeper within the dermal layers.
• Mesopeels are specially formulated chemical peels that can address a wide variety of hyperpigmentation, discoloration, and melasma and help control melanocyte activity. They use a process of chemo exfoliation that not only helps revive the surface of the skin like a traditional chemical peel but also induces new collagen and elastin production in the skin. Mesopeels are safe to use on a wide variety of treatment areas of the body and can be combined with melanostop tran3x to remove pigmentation from the skin.
• Clear + Brilliant is commonly called a “baby Fraxel” because it uses gentle technology to exfoliate the top layer of skin, remove dead skin cells, and stimulate new collagen. Clear and Brilliant treats hyperpigmentation without any downtime. The Permea handpiece of the Clear+Brilliant ® was designed solely to treat hyperpigmentation for patients of all skin types and tones.
• V-Beam Laser is a pulsed-dye, skin-resurfacing laser that has long been popular among patients looking to reduce the appearance of redness and pigmentation on the surface of the skin. Recent studies have confirmed that the V-Beam Laser is a safe and successful treatment to reduce the redness and hyperpigmentation of melasma, specifically, helping patients restore their skin.

Cosmelan – 10 weeks before and after

Which sunscreen should patients with melasma use?

Sunscreen is one of the most important skincare products for protecting against premature signs of aging, preventing skin cancer, and keeping melasma from developing, worsening, or recurring. This is critical for melasma patients because the skin cells that make melanin (pigment, the melanocytes, are triggered to make more pigment by UV exposure. When areas that have already been treated for melasma get sun exposure, the melanocytes may be stimulated to reproduce pigment, causing melasma to return. For all patients with melasma, Dr. Green recommends layering sunscreens. When choosing a sunscreen for patients with melasma, it is best to use an SPF of 50 or higher.  In addition, Dr. Green recommends a combination of chemical and physical sunblock.  Melasma patients are much more sensitive to the sun, and layering both types of sunscreens can provide you with the best possible sun protection.  Physical sunscreen, also called mineral sunscreen, creates a physical barrier on the skin that filters out and defends from damaging UV rays. Physical sunblocks generally contain titanium dioxide or zinc oxide.

Chemical sunscreens absorb and scatter UV rays, are generally water-resistant, and are less likely to leave a white residue behind.  Common active ingredients used in chemical sunblocks are oxybenzone, azobenzene, octinoxate, and octisalate, among others. When choosing a sunscreen formulation, it is always wise to choose one that is non-comedogenic, oil-free, paraben-free, and fragrance-free.

It is very important to limit sun exposure during and after melasma treatment. When outside, try to wear a broad-brimmed hat and protective clothing, and discontinue hormonal medication use when possible. It is essential to reapply sunscreen every two hours and even more frequently if you go swimming or do any rigorous exercise that involves excessive sweating.

Will melasma go away?

Melasma is a chronic skin condition that does not have a cure, but it can be treated so that it is less visible. Visible dark patches associated with melasma do go away with the proper treatment options. For some individuals, melasma will go away on its own, depending on what the triggers are. Melasma that is a result of hormones due to hormonal oral contraceptives or pregnancy may fade on its own within a few months after birth. Other treatments like the Cosmelan peel can greatly reduce melasma and restore clear, even skin tone. However, a reoccurrence is always possible if you do not maintain the proper skincare routine and if you fail to apply sunscreen with an SPF of 30 and above on a daily basis. Additional studies that A.G. Pandya and colleagues have done have indicated that oral tranexamic acid is another beneficial treatment that can be used to lighten the appearance of melasma significantly. Dr. Green can advise which combination of treatments, supplements, and topicals will be the best to get rid of your melasma once and for all.

Which procedures should I avoid with melasma?

It is extremely important to avoid the majority of laser treatments, such as the IPL, Fraxel, or Picosure laser, in treating facial melasma, as these can result in post-inflammatory hyperpigmentation. Dr. Michele Green has years of experience in treating melasma and feels that the most difficult cases of melasma to treat are those that have undergone these laser treatments. These lasers seem to “burn the pigmentation” into the skin and make it much more difficult to remove this hyperpigmentation. There are only a few laser treatments that are gentle enough to treat melasma, such as the Clear + Brilliant and V-Beam lasers.

If you are being treated for melasma, it’s best to start with non-invasive techniques, such as the Cosmelan peel, mesopeels, microneedling, HydraFacials, or microdermabrasion. Additionally, it’s important to treat melasma under the careful supervision of a board-certified dermatologist like Dr. Michele Green. Dr. Green often encounters patients who have attempted to treat pigmentation at medical or aesthetic spas, and, in many cases, these attempted treatments can make the appearance of melasma much worse. Dr. Green understands the importance of accurately diagnosing and treating pigmentation the first time around, and the safety and satisfaction of her patients are her top priority. It is also important to note that you should not treat melasma while you are pregnant or nursing.

Will melasma go away on its own?

Melasma is a skin condition that is associated with a number of underlying causes. In some cases of melasma, the dark patches of skin can fade away on their own once the underlying cause has been resolved. For the majority of patients who observe that their melasma has gone away on its own, the underlying cause is hormonal. For patients who have melasma that began to develop during pregnancy, as a result of taking hormonal contraceptives, or due to undergoing another form of hormonal therapy, melasma may go away on its own once hormones are regulated. Most patients with melasma, however, do require intervention in order to resolve the hyperpigmentation on the skin completely. For some, intervention may simply mean that they begin to incorporate skin-lightening skin care products such as those containing hydroquinone. Though some patients may see some improvement by using topical treatments, most men and women with melasma do achieve the best cosmetic results through non-invasive treatment with a board-certified dermatologist, such as Dr. Michele Green in NYC. Melasma can be a difficult skin condition to treat and manage, and entrusting an experienced and knowledgeable expert to develop your treatment plan is the easiest, fastest, and safest way to clear your complexion and get long-lasting, beautiful, youthful skin. Dr. Green has over two decades of experience treating some of the most discerning men and women from around the world, and she will take the time to customize your melasma treatment plan so that it works best for your specific skin concerns and aesthetic goals.

Is Melasma Genetic?

While the exact cause of melasma remains unknown, it is thought to have a genetic component. Many patients who struggle with melasma could have a genetic predisposition for the skin condition, and 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 the skin condition. The presence of melasma can not be attributed to any singular causal factor but rather a combination of contributing factors, including genetics.

Is Melasma Cancerous?

Skin cancer is a serious skin condition caused by the uncontrolled growth of abnormal skin cells. Trying to determine whether dark spots are benign areas of hyperpigmentation or something more serious, such as skin cancer, can be a challenge when one isn’t sure of what to look for. Whether pigmentation is triggered by too much sun exposure or other causes, it’s important to carefully observe any dark-colored or brown patches on the skin to ensure that there is no risk of melanoma or skin cancer. Additionally, even when pigmentation is not a sign of something more insidious, inconsistencies in skin tone can make patients feel self-conscious about how their skin has changed. The best thing to do when you notice a dark patch of skin is to schedule an appointment with a board-certified dermatologist like Dr. Green. This way, more dangerous skin conditions such as skin cancer may be ruled out, and an appropriate treatment plan can be established.

Where does Melasma come from?

Melasma is a skin condition that can be attributed to a combination of factors, including genetics, hormones, environmental conditions, and certain medications. 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. Individuals with medium to dark skin tones are more prone to developing melasma than those with lighter skin tones. This is 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.

Does HRT cause Melasma?

Hormonal changes have been linked to the development of melasma, and any medications, therapies, or supplements that induce hormonal changes can potentially lead to melasma. This includes HRT, which can affect levels of estrogen and progesterone. Estrogen and progesterone are two of the hormones linked to melasma. However, HRT can be beneficial for managing the symptoms of menopause as long as the benefits outweigh the risks. If you’re taking HRT and have noticed dark spots or patches of melasma develop, schedule a consultation with Dr. Green. Dr. Green will work with you to manage the appearance of melasma so that you can restore your skin tone and continue to look and feel like the best version of yourself.

Can Microneedling Cause Melasma?

Microneedling, a cosmetic treatment option that’s also referred to as collagen induction therapy, is a safe and effective procedure for treating melasma and usually will not worsen the skin condition. The treatment involves using a handheld device containing tiny, sterile needles to create micro-injuries in the skin’s surface, which stimulates new collagen and elastin production. This results in smoother, brighter skin and a more even skin tone. Patients interested in treating unwanted pigmentation, including post-inflammatory hyperpigmentation and melasma, can benefit from pairing their microneedling treatment with a topical depigmenting serum. The topical depigmenting serum used by Dr. Green at her private dermatology office in NYC is from Mesoestetic, a global leader in depigmentation treatments. It is a unique blend of powerful yet gentle skin-lightening agents, including kojic acid, tranexamic acid, and azelaic acid, that work together against melanocyte activity in the skin. The result is an even-toned complexion with an observable reduction in hyperpigmentation. Patients enjoy that after their microneedling treatment with depigmenting serum, their skin tone is even, their face is more radiant, and they have a lasting healthy glow. This treatment option may be preferable to patients with highly sensitive skin who may be irritated by chemical peels or laser treatments.

Can Melasma appear suddenly?

Usually, melasma develops gradually over time. However, there are some risk factors for the seemingly sudden appearance of melasma, which can include increased stress, certain medications, sun exposure, or hormonal changes. If you notice new or developing dark spots or patches on the skin, schedule a consultation with an expert, such as board-certified dermatologist Dr. Michele Green. Certain laser treatments, such as Fraxel, Picosure, and IPL, can cause immediate worsening of melasma and should be avoided. Dr. Green has over 25 years of experience providing some of the world’s most discerning individuals from around the globe with the best non-invasive treatment options, including melasma treatments. Whether your melasma has gradually worsened over time or seemingly appeared suddenly, Dr. Green will work with you to develop a customized treatment plan for reducing the appearance of melasma and restoring a bright, even-toned complexion.

How do I get started with the best Melasma treatment today?

Although melasma is a common, benign skin condition, the presence of patchy skin discoloration and dark spots can, for many, induce feelings of self-consciousness regarding their appearance. Melasma can be a challenging skin condition to treat and manage, especially without the guidance of an expert. If you are frustrated by the presence of dark patches of skin associated with melasma, board-certified cosmetic dermatologist Dr. Michele Green in NYC is here to help. At her private dermatology office in the Upper East Side of Manhattan, Dr. Green offers a host of non-invasive cosmetic treatment options for eliminating unwanted hyperpigmentation on the face and the body to achieve a clear, radiant, beautiful complexion that lasts.

Dr. Green 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 men and women from around the globe with the best non-invasive treatment options, including microneedling, chemical peels, and laser treatments for hyperpigmentation and melasma. Dr. Green takes a holistic approach and embraces a less-is-more philosophy regarding facial rejuvenation, customizing each patient’s treatment plan to suit their particular concerns and aesthetic goals. She is consistently identified as one of New York City’s best dermatologists by Castle Connolly, New York Magazine, Super Doctors, and the New York Times for her dedication to her patients and expertise. With over 25 years of providing the best cosmetic solutions for patients from around the world with various skin problems, she has unmatched experience when it comes to treating melasma for patients of every skin type and skin color. If you are in search of the best melasma treatment in New York, please call our office at 212-535-3088 or contact us online to schedule a consultation and get started developing your customized treatment plan with Dr. Green today.