Mysterious Melasma: Misunderstood and misdiagnosed.

Melasma is a pigment disorder that can be challenging to treat. It’s also one of the most misunderstood and misdiagnosed skin conditions.

And you’ve got it! Or, you might have it. But you’re not sure. You’ve spoken to many skin experts, and some say it’s sun-induced hyperpigmentation, while others say it is indeed the hormonal condition known as melasma.

So which is it?

It is sometimes also called chloasma and is often referred to as hyperpigmentation. Okay, great, but what causes it, and how is it different from sun-induced hyperpigmentation?

That’s a good question. But before I explain, it’s worth repeating: misdiagnosis of this skin condition is common. Given that it’s a skin pigment disorder, you would think it wouldn’t be such a big deal. But it is. Tackled in the wrong way, and the results can be disastrous!

Melasma can appear as darkened skin, but it’ll look different from blotchy pigment caused by years of sun exposure. Melasma will appear mask-like. It appears symmetrically and in particular areas of the face and body. It may appear on the upper lip, giving the appearance of a moustache, or it can show up across the forehead or large patches across the cheeks, a bit like a butterfly. 

The catalyst? Usually, pregnancy, hormonal birth control or hormone replacement therapy for menopause.

Melanin cells, known as melanocytes, are activated when the skin is exposed to UV radiation. The skin becomes tanned and thickened to protect it from future sun exposure.

Exposure to heat can trigger melasma, either directly from the sun or when the skin is becoming heated in other ways. 

Sitting in front of a fire, leaning over a hot stove or BBQ, or being in an overly hot room can all trigger melasma. Even a glass of wine can send a rush of heat into the skin and activate melasma.

In many cases, cessation of hormonal medications or when you’re no longer pregnant will usually improve the severity of melasma. But not always, especially if you spend a lot of time outdoors.

Sun protection is essential in minimising melasma; however, when outside and exposed to the sun, your usual sun protection will do little to minimise melasma as sunscreens don’t protect your skin from the infrared heat of the sun.

Of course, while wearing sunscreen, you may not be getting burnt, but your skin is still getting hot, and heat is a trigger for melasma.

Why nothing’s working?

Melasma can be incredibly frustrating if misdiagnosed and treated as sun-induced hyperpigmentation, and it can lead to a worsening condition.

Treatments such as Laser or IPL that heat the skin can be the worst thing you can do and often stimulate a further cascade of unwanted pigmentation. So, be wary if you think you have melasma, and IPL or Laser has been recommended for your problem.

You may be feeling all is lost.

Feeling confused is natural, but melasma can be resolved with the right care and patience. Getting the correct advice is crucial. Sometimes, the difference between melasma and sun-induced hyper-pigmentation can be subtle.

However, if you’re able to pinpoint the arrival of your pigment with any hormonal event such as pregnancy or hormonal birth control and the pigment appears symmetrically or in an unusual place like your upper lip, then it’s probably melasma.

But, don’t second guess, get the advice of a skincare professional.   

In the meantime, what can you do?

Whether you have melasma or sun-induced hyperpigmentation, the following will help reduce the visible symptoms of blotchy pigment.

Sun protection—Although melasma is not directly caused by the sun, wearing broad-spectrum sunscreen is essential. But there’s more you can do to protect your skin while it settles down.

Niacinamide, also known as vitamin B3. It’s an excellent choice to include in your daily skin protective routine. Niacinamide will protect your skin from the heat of the sun, which is one of the primary triggers of melasma.

Vitamin C is another essential nutrient that protects skin from the sun’s heat. Topping up your skin’s supply of vitamin C protects the skin and minimises the enzyme activity that creates melanin.

Vitamin A is one of the skin’s most valuable nutrients. It’s your skin’s natural sunscreen. Unfortunately, sun exposure destroys vitamin A, so topically applying vitamin A serum or cream every day is essential for minimising melasma.

It’s important to note that all three nutrients, vitamins A, C, and B3, are protective and are often found to be deficient in the skin. 

Hydroquinone – A bleaching agent which is only available with a prescription from your doctor. I’m not a fan of this; however, in small, controlled doses, it can help.  I recommend a thorough examination with a dermatologist if you want to try hydroquinone. 

Chemical Peels – It will largely depend on which type of peel you have. In my experience, most superficial peels, while helpful, will not eliminate melasma.

One such peel that is getting a lot of attention is cosmelan. While I’ve not experienced it myself, many skin therapists that I know highly recommend it as an option for melasma.

IPL and laser treatment are not recommended if you have melasma. They are heat-related devices* and will aggravate and trigger your melasma. 

*IPL and Laser treatments heat the skin, and any heating of the skin will make your melasma worse.