There are two key actives required for managing hyperpigmentation: patience and diligence. A third requirement is to have realistic expectations. I have finally come to the breakthrough conclusion that there is a regimen, rather than a single treatment or product application, which is required to make any inroads on fading dark spots and Melasma.
First, you need to appreciate that hyperpigmentation is stubborn. It has taken years, probably most of your adult life, to form. Mostly it comes down to melanocyte activity. There are typically between 1000 and 2000 melanocytes per square millimeter of skin and make up about 5% to 10% of the cells in the basal layer of epidermis (incidentally, black and white skins possess the same number of melanocytes).
Freckles, for example, are red patches due to hyperactive melanocytes that start in infancy, particularly in fair skins, and on exposed areas of the epidermis. Chloasma, also known as Melasma and the ‘pregnancy mask’, is due to excessive melanocyte activity forming symmetrical patches on the face in pregnancy or as a result of oestrone/progesterone therapy. Senile-lentigines or liver spots are brown patches on the forearms, face and hands due to a proliferation of melanocytes.
It is widely believed that Melasma begins because of a change in hormone levels, whether it is with a pregnancy, beginning birth control pills, or beginning your menstrual cycle. It is also widely believed that when a woman goes through “the change of life” estrogen production slows and eventually ceases. When there is no longer estrogen in the body, Melasma will often go away. However, the change of life doesn’t occur in most women until they are well into their 50’s and most prefer not to wait for that to happen. Therefore, I recommend beginning and maintaining a regimen now to keep the Melasma at a bare minimum and tolerable until it may go away on its own.
Before you begin, you must know there is no cure for Melasma or excessive pigmentation. Totally eliminating it with any one treatment or product is not possible, but reducing the appearance of Melasma and hyperpigmentation drastically is possible. The best approach I have found is not one particular product or treatment alone, but a combined therapy instead.
1. Melanin Inhibitor – This is often referred to as a bleaching agent for the skin. Hydroquinone is the most widely known chemical compound for effectively bleaching areas of Melasma. However, using Hydroquinone for extended periods of time is frowned upon and not recommended. After using it for up to 12 weeks, you must discontinue and begin alternate products to follow up the improvement attained.
2. Exfoliate – Retin A is an effective exfoliant and offers other benefits as well to help improve the overall integrity of the skin. Retin A works to pull pigment closer to the skin’s surface allowing the Hydroquinone to do its job better. Retin A also minimizes fine lines and wrinkles and encourages collagen production.
3. IPL Therapy – Photo Rejuvenation is by far one of the best treatments to help lighten pigment and lightening Melasma pigment is no exception. When IPL is used in the hands of a skilled, certified technician, visible results are the outcome as IPL pulls the pigment closer to the surface of the skin and eventually disappears.
4. Fractional Ablation – Fractionally Ablative treatments employ different types of fractionally ablative lasers and CO2 lasers that will help eliminate melasma. They treat both the superficial and deeper layers of pigment. Boring out small columns of hyperpigmented skin, the areas of Melasma pigment become smaller.
5. Light Chemical Peels – Light chemical peels such as Lactic Acid and Glycolic Acid peels help to keep pigmentation to a minimum and can be received as often as once a month as maintenance. (Always discontinue Retin A 48 hours prior to any chemical peel.)
6. Product – As always, on-going product use is the insurance policy to protect the treatments you’ve set in place and to extend their result. Products instrumental in maintaining continued results would be anti-oxidant serums, bleaching agents (both chemical and natural), and sunscreen.
Because, as mentioned earlier, there is no 100% cure for Melasma, the results and how long the results last are directly dependent on you. While no one can live in a cave, you MUST NOT allow sun exposure on your skin! This means layering sunscreen on your skin every single day, whether you are outside or not. Wearing a broad-brimmed hat when outside in the yard, at the lake, at a ball game, etc. is paramount! Re-application of sunscreen every 1-1/2 hours of time you are outside it an absolute. The more sun exposure you allow yourself to have, the quicker the Melasma will return and the darker it will become over time.
Combining treatments and products work best to keep the effects of Melasma and hyperpigmentation at bay. Diligence is the key.