Melasma is defined as the patchy darkening of skin in sun exposed areas, typically on the face. The cheekbones, cheeks, and forehead are most commonly affected. 90% of cases occur in women and it is thought to be related to hormonal activity, especially progesterone, but the exact mechanism is not known. Melasma is most common in medium-pigment skin, such as in Asians and Hispanics.
The patches of increased pigment begin very gradually but can become quite noticeable and bothersome. The “mask of pregnancy” is a manifestation of melasma. Starting oral contraceptives can also bring on melasma.
Melasma is challenging to treat. First and most importantly, the stimulus for the melasma must be addressed. Strict sun avoidance is a requirement. Even visible light can stimulate melasma lesions, so sunblocks are not adequate by themselves, since they only screen out UV light. Second, if oral contraceptives are being used, alternatives should be explored.
The mainstay of melasma treatment is topical. Hydroquinone is the foremost bleaching cream that inhibits the enzyme in the skin that makes melanin. There are alternative bleaching agents, such as kojic acid, but hydroquinone is the best-studied and gives the best results. Retinoic acid is also helpful by speeding up skin cell turnover. When hydroquinone, retinoic acid and a topical steroid are used as a triple combination together, the best results occur. Even so, results take months to achieve, and sun avoidance must be maintained .
Lasers and chemical peels are an option to speed the improvement of melasma. Chemical peels remove the overlying layers of pigmented epidermis and so are helpful. However, they will not penetrate into the deeper layers of skin pigment. Fractionated laser, such as Fraxel, can be helpful but there is a small risk of reactive hyperpigmentation. Q-switched Nd:YAG is also helpful and works by a different mechanism, similar to laser tattoo removal. However, all these methods are adjuncts to topical treatment and will not achieve good results without pretreatment with topicals.

With the summer months coming up, we’ll be spending more time outside, exposing more skin and going to the beach.  Many will go on beach vacations.  If you’re getting a tattoo removed or other laser services beforehand, you should take steps to protect your skin.  The sun intensifies the body’s tendency to darken (hyperpigment) any part of the skin that is healing or has some inflammation.  The darker your skin is naturally, the more of a tendency there is for this to happen.

When you get a tattoo lasered, or laser hair removal for that matter, the skin could darken if left exposed to ultraviolet light.  The best solution is to keep these areas covered for at least several weeks.  However, this is not always possible.  The next best is to put on the strongest available sunscreen.  At Tattoo MD, we carry and recommend Solar Protection Formula SPF 58 water-resistant sunscreen.  Not only is it powerful, it is a physical sunblock containing zinc and titanium dioxides and is PABA-free.

Hyperpigmentation after laser treatment is not always avoidable but there are steps you can take to minimize it.  Also, it is fortunately temporary and fades away with time.

Latisse is the new FDA-approved treatment to make lashes longer and fuller. Differences were amazing at 6 months and side effects were uncommon and minor in the FDA study. It took us a very short time, after reviewing the safety and efficacy profile, to add Latisse to our menu of services. Latisse is made by Allergan, the makers of Botox. TMD Medi-Spa will now carry Latisse for only $125 per vial. You will typically start seeing results after 3-4 weeks. A free consultation is necessary to ensure that Latisse is right for you. Go to the Latisse page here.