While there is no cure for melasma, many treatments have been developed. The discoloration usually disappears spontaneously after pregnancy or stopping the oral contraceptives. Management of melasma requires a comprehensive and professional approach by your dermatologist.
Treatments to hasten the fading of the discolored patches include:
a. Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.
b. Tretinoin an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
c. Azelaic acid (20%), thought to decrease the activity of melanocytes.
d. Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.
e. Laser treatment. A Wood’s lamp test should be used to determine whether the melasma is epidermal or dermal. If the melasma is dermal, laser (or "IPL") will acually DARKEN and worsen the appearance of the spots. Dermal melasma is generally unresponsive to most treaments, and has only been found to lighten with products containing mandelic acid.
In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production. Cosmetic cover-ups can also be used to reduce the appearance of melasma.
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