Boston Melasma Dermatologist
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What is Melasma?
Melasma is a skin problem, resulting in brown patches on the face. The cause is uncertain. However, it is probable that melanocytes, the color-making cells in the skin, produce more melanin (pigment) than usual.
Where can you get Melasma?
The melasma brown patches often appear in a symmetrical pattern on the face mostly on the:
- Cheeks
- Forehead
- Above the upper lip
- Chin
Who Gets Melasma?
- Women more often than men get melasma
- People with darker skin. Ex: Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent
What Are the Risk Factors Associated With Melasma?
- Sun exposure
- Change in hormones – pregnancy, contraception hormones such as birth control pills, hormonal IUDs and hormonal implants
Why Is It Best to Choose The Dermatology Institute of Boston for Melasma Treatment?
The Dermatology Institute of Boston is considered one of Boston’s top clinics for dermatology. Our internationally renowned board-certified dermatologists have years of experience diagnosing, treating, and creating personalized melasma management plans for Back Bay patients.
Our founder, Dr. Emmy Graber, was Director of the Cosmetic and Laser Center at Boston University and was also the associate residency program director. She won the Top Doctors 2024 award from Castle Connolly and is a 2024 Boston “Top Doc” and is regularly published in medical journals.
Our dermatology experts have deep knowledge when it comes to sun protection and retinols. They have been quoted in an article about sunscreen in The Improper Bostonian, The Boston Globe, “Five Places You’re Probably Forgetting to Wear Sunscreen” in Boston magazine, and numerous other publications.
What Is the Best Melasma Treatment?
There are a number of treatments that can potentially help lighten melasma patches. These include medications and non-invasive skin treatments. Combinations of these treatments are typically recommended by the board-certified dermatologists at our Boston clinic, since combinations tend to create optimal results.
Note that melasma caused by risk factors such as pregnancy or birth control pills may fade naturally on its own over time. After you’ve delivered your baby or stopped taking birth control, the hormonal changes that triggered the melasma will have ceased and the melasma may then lighten.
At The Dermatology Institute of Boston, located near Copley Square, our dermatology experts will create a personalized treatment plan tailored to your skin type, melasma depth and severity, medical history, and melasma triggers.
Melasma Medicines
Hydroquinone – This prescription-only chemical bleaching cream inhibits the tyrosinanse enzyme, stopping pigment synthesis. As a result, melanin pigment creation decreases and melasma is reduced. A thin layer is applied to the skin’s surface once or twice daily for several months. Depigmentation can typically be noticed after five to eight weeks of use and increases with time.
Tretinoin and corticosteroids – Taking these medications in combination reduces the appearance of melasma. Tretinoin is a vitamin-A-derived retinoid that decreases melanin production and encourages skin-cell turnover. Mild topical corticosteroids further encourage skin-cell turnover while decreasing skin inflammation. Tretinoin typically results in skin irritation, but corticosteroids reduce this effectively.
Kojic acid – Like hydroquinone, kojic acid inhibits the tyrosinase enzyme, reducing melanin production and melasma. It’s gentler on the skin and is typically combined with other melasma treatments and medications to boost results. Kojic acid is created by fungi and possesses strong antioxidant properties, along with antibacterial and antifungal properties.
Azelaic acid – This naturally occurring tyrosinase enzyme inhibitor reduces melanin production, gently exfoliates skin cells, and encourages cell turnover. It also has antibacterial and antioxidant properties, decreasing skin inflammation and damage. Unlike many other melasma options, azelaic acid is safe for pregnant and breastfeeding women. It is found in wheat, rye, and barley.
Other topical medicines – Several other topical medicines are available, including ascorbic acid (vitamin C) creams, which are a very gentle tyrosinase-inhibitor option. Triple combination creams feature tretinoin, hydroquinone, and a corticosteroid. Other creams feature combinations of kojic acid, hydroquinone, and tranexamic acid. Thiamidol is another topical medication which will soon be available over the counter in the United States to treat melasma. Thiamidol also works by inhibiting the enzyme tyrosinase in order to block melanin production.
Sunscreen – Regular sunscreen use, even in the winter months, is critical to improving melasma. A good sunscreen for melasma should be SPF 30 or higher and it should be a broad spectrum sunscreen, meaning that it blocks against both UVA and UVB light (ultraviolet A and ultraviolet B light). Sunscreen must be applied everyday – even in the winter and even on cloudy days.
Melasma Procedures
Chemical peels – Chemical peels like the VI Peel gently encourage sloughing away of superficial skin layers using a combination of acids. This triggers an increased cell-turnover rate and a reduction in melanin pigment creation. Light and medium depthpeels are available.
PicoWay laser – this pico laser by Candela is a state-of-the-art way to lighten melasma at the Dermatology Institute of Boston. It often requires more than one treatment and may result in a temporary darkening of the skin. This treatment is not covered by insurance and the price varies on the extent of a patient’s melasma. A cosmetic consultation with one of our dermatologists will help guide you in the number of treatments, downtime and price.
How to Prevent Melasma
While nothing can completely prevent melasma, avoiding any potential triggers is key. Use protection such as sunscreen and a wide-brimmed hat.
Learn more at the Laser Treatments’ page: Brown Spot Treatment.
Learn more at the American Academy of Dermatology: AAD Melasma.
Consultation With a Melasma Dermatologist
Call or contact our Boston office to schedule your Melasma dermatology consultation with Dr. Graber, or our staff of highly-trained professionals.
Melasma FAQ
What is the fastest way to cure melasma?
The time it takes to see melasma results from a chemical peel depends on the exact depth of the chosen peel. Lighter peels show results in weeks, while medium and deeper peels take months. However, the exact number of peels required to produce results will also vary based on peel depth.
The exact time required to see results from melasma medications varies from person to person. Generally, it takes weeks to months to improve melasma. Patients who are in the sun more often, or those who are on hormonal medications, may have melasma for years.
As is often the case in dermatology, the fastest way to achieve results from melasma treatment is typically by pairing treatment modalities. This method tends to greatly enhance results.
Can melasma be permanently removed?
Melasma cannot be permanently removed, and there is no cure for this condition. Even with the treatment options that work best for you, melasma may still reappear frequently, especially if one is in the sunlight. However, effective management of this condition is possible.
Working with a board-certified dermatologist at The Dermatology Institute of Boston is the best way to manage melasma and reduce recurrences. Arrange a consultation at our office, located on Dartmouth St. and Stuart St. During a consultation, you and your dermatologist will go over your melasma triggers and the best ways to minimize them. Your dermatologist will design an effective strategy for maintaining results.
Once you have achieved results with melasma treatments, you will need to avoid UV (ultraviolet) light exposure. Proper and consistent sun protection is vital. Use high-SPF sunscreens and minimize direct sun exposure when the sun is at its strongest (between 10:00 am and 4:00 p.m.) Tanning beds must be avoided.
Changes in one’s hormone levels are another common trigger. Thyroid conditions and pregnancy can both affect hormone levels, as can various medications (like birth control pills and hormonal IUDs).
You must also continue to use melasma treatment modalities as directed. Various skin lighteners and retinoids can help ensure that melasma is minimized. Hydroquinone therapy can be used as part of this, but only intermittently. Chemical peels may also be included.
Following your recommended daily and nightly skincare routine is key. Topical antioxidants, thiamidol, azelaic acid, and kojic acid can help prevent worsening and sunscreen can offer additional sun protection during the day while retinols (such as tretinoin) can help exfoliate skin cells overnight.
