Healthy, normal skin has an even skin tone and is free of dark areas caused by excess melanin (hyperpigmentation) or light spots void of melanin (hypopigmentation). The variance in pigmentation does not cause any physical or imminent harm but can make people feel self-conscious about their appearance.
Simply put, hyperpigmentation is a common skin condition that causes discolored or dark spots anywhere on the skin. Compared to the rest of the complexion, hyperpigmented areas appear deeper in color and stand out visually.
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TYPES OF HYPERPIGMENTATION
Hyperpigmentation is more prevalent than hypopigmentation and can develop at any age, most seen in people 20 to 50 years old. Although it can present itself in many ways, there are three main types.
Photo-aging is also referred to as age spots, sunspots, liver spots, or solar lentigines (freckles). These spots typically appear with older age on the face, hands, or sun-exposed areas of the body. Photo-aging presents itself as a smattering of small brown, tan, or even black spots on the skin and are directly related to excess sun exposure over time. This is usually found in clusters of dark spots and larger than hereditary lentigines (freckles). Freckles are mostly predisposed from childhood and appear more prominent along the bridge of the nose and cheeks.
Anyone with a history of acne is probably familiar with post-inflammatory hyperpigmentation, as this is caused by either inflammation or an injury to the skin. Inflammatory skin conditions, such as eczema and acne, are well-known culprits of post-inflammatory hyperpigmentation that create spots and patches of darkened skin. Other causes can be as simple as a scratch, insect bite, or a picked comedone.
Melasma is a chronic condition also called chloasma or pregnancy mask, that generates large gray or brown patches of darkened skin typically on the forehead, face, and stomach. Hormonal influences play a major role in the development of melasma, which is what sets it apart from traditional hyperpigmentation conditions and makes it significantly tougher to treat.
DIFFERENTIATING MELASMA
According to the American Academy of Dermatology, about 90% of people that develop melasma are women, leaving diagnoses with men rarer but possible.
Because hormones are the main trigger behind melasma, it can be difficult to remove the instigating factors and implement treatment. Although melasma is not painful and does not prompt any health risks, it can create emotional distress for clients as it is most commonly present on the face like a port wine stain. Melasma currently affects an estimated six million women in America, more so with higher Fitzpatrick scale complexions. Individuals with darker skin tones are more prone to experience melasma, especially people of Latin or Hispanic, Asian, Indian, North African, Mediterranean, and Middle Eastern descents. Additionally, people that have blood relatives that previously had melasma are more likely to get it.
When chloasma (a temporary condition that brings on large brown patches) happens during pregnancy, it is referred to as melasma. The increase in estrogen during pregnancy stimulates the production of melanin and can trigger hyperpigmentation like melasma or the linea nigra (the dark line down the center of the belly developed during pregnancy). Hence why melasma is lovingly referred to as the pregnancy mask.
Melasma can affect people at any stage of life, not just during pregnancy. It can fade away on its own as a temporary condition, or it can linger for several decades.
HOW TO IDENTIFY MELASMA
Contrary to popular misconception, melasma typically appears with matching, symmetrical blotchy marks on both sides of the face. Because of this, most medical professionals can diagnose the condition with a simple visual examination and no further testing. However, to rule out abnormal causes, health care providers may perform additional tests.
A Wood’s lamp is a great tool for identifying several underlying skin conditions, including melasma. The special light provides the technician the ability to check for any bacterial and fungal infections and determine how many layers of the skin are affected. For more serious forms of melasma, a biopsy may also be performed to remove a small piece of affected skin for additional laboratory tests.
Melasma appears in three common facial patterns including centrofacial (center of the face), malar (cheekbones), and mandibular (along the jawbone). Less routine locations for melasma to appear are the upper sides of the neck and other body parts like forearms.
Four types of pigmentation patterns seen with this skin condition include epidermal melasma (excess melanin in superficial skin layers), dermal melasma (seen by melanophages throughout the dermis that ingest melanin), mixed melasma (includes both epidermal and dermal features), and excess melanocytes (seen in darker skin complexions).
CAUSES OF MELASMA
The exact root cause of melasma is still not clear. However, the two agreed upon factors that lead to melasma are hormones and sun exposure.
People with more active melanocytes are more prone to develop this hyperpigmentation disorder. Conditions such as pregnancy, Addison’s disease (affecting the adrenal gland), stress, thyroid disease, eczema, and psoriasis are known triggers of melasma. Certain medications are also components that can cause a flare-up such as antibiotics, anti-seizure drugs, antiarrhythmics, and antimalarial drugs.
Pregnancy comes with waves of hormones that are believed to be linked to melasma like estrogen, progesterone, and melanocyte-stimulating hormone, especially during the second and third trimesters. These sensitive hormones are also found in birth control pills and various hormone therapies. Some studies have shown that progesterone hormone replacement therapy given to post-menopausal women are more likely to develop melasma versus those that receive estrogen alone.
Sunlight, as it is with most hyperpigmentation causes, can exacerbate melasma due to the potential to stimulate melanocytes. Surplus pigment in unhealthy skin cells gets dumped into lower levels of the skin, forming splotchy melanin pools on the surface of the skin.
PREVENTATIVE MEASURES
No surprise here but minimizing excessive sun exposure and wearing sunscreen are the first and best line of defense to prevent melasma hyperpigmentation from developing or worsening. Since ultraviolet rays drive melanocyte processes in the skin, cutting off exposure allows the skin to heal over time.
Best practices for sunscreen include using formulas that contain a minimum of SPF 30 (or higher), physical blockers such as zinc oxide, titanium dioxide, or Parsol 1789 (avobenzone); and only contain chemical blockers such as oxybenzone.
Chemical-centric sunscreens do not offer as much protection, especially for melasma clients. In some instances, they could even trigger adverse allergic reactions that will worsen the condition. It is always wise to choose a product that will prevent all rays and wavelengths from penetrating the skin. A skin care professional could also recommend makeup that contains iron oxide to add an additional protection layer.
Heat and visible light are other factors that could irritate melasma, so some dermatologists recommend wearing a wide-brimmed hat when outside as sunscreen alone may not provide ample protection. Avoid obvious heated areas like saunas, steamy kitchens, or places like the gym due to the heat index.
MELASMA TREAMENTS
Most hyperpigmentation conditions respond well to typical lightening treatments available in over-the-counter products. Key ingredients like vitamin C, kojic avid, licorice root, niacinamide, green tea, azelaic acid, glycolic acid, and retinol aid to lighten and brighten the surface of the skin. This is done by suppressing melanocytes into deeper layers of the skin and are safe to use for long-term maintenance. However, those same ingredients have not produced a consistent success rate when tasked to treat melasma.
The deeper and more severe the pigmentation, the more challenging it is to treat. Consistency with homecare is vital, but more advanced treatments can aid in the treatment protocol. Chemical peels, intense pulsed light, dermabrasion, and microneedling are often used in conjunction with lightening agents to achieve better results. These professional treatments help strip away the top layers of skin and lighten the undesirable patches of dark spots.
For more progressive stages of melasma, some doctors prefer to prescribe aggressive bleaching agents such as topical steroids, tretinoin, corticosteroids, or hydroquinone products. These help block melanin production and stop the melanin from making it to the epidermis layer of skin. While hydroquinone products can be purchased over-the-counter, they should only be used under a doctor’s care. Over-the-counter versions usually contain less than 2% of the active ingredient and are less effective and potentially unsafe.
It is critical that practitioners urge melasma clients not to self-treat the condition without consulting professional medical advice. Oral or injected glutathione products and ingredients alike are noted across the internet as treatment options that are not FDA-approved. Using such products could result in potentially dangerous kidney and thyroid issues aside from not addressing the melasma hyperpigmentation.
The skin is a complex organ and each skin type reacts differently to treatment options. Any of the mentioned ingredients or procedures do not guarantee to eliminate melasma but could help lighten the affected areas. Treating melasma is not a quick-fix or easy solution as most clients require months of consistent treatment and follow-up visits to their doctor.
HOMECARE
As mentioned, a consistent homecare routine is essential for the success of any skin care protocol. Environmental factors like airborne pollutants can weaken the lipid barrier of the skin as they make it more susceptible to sun damage. A few simple homecare steps to keep melasma at bay include:
- • Twice a day cleansing with gentle products that thoroughly remove particulate matter
- • Use a serum that is chock full of antioxidants (vitamin C and vitamin E) to fight off free radicals
- • Moisturize regularly (twice daily) to restore the necessary fats and proteins in the skin
- • Practice patience because melasma may take weeks, months, or even years to clear up
- • Commit to sun protection and be diligent about wearing proper sunscreen everyday
MAKEUP TECHNIQUES FOR COVERING UP MELASMA
Camouflage makeup is an essential skill that skin care practitioners need to master, especially aestheticians. With the appropriate products and techniques, makeup can be used immediately following a trauma-induced treatment or to empower clients to feel their best (including clients suffering with melasma). Camouflage makeup applications can be offered as an add-on or stand-alone service, depending on the level of detail the client is looking for.
Sheer formulas will not cover the pigmentation and will peek through the final look. The best products to use when covering something as severe as melasma consist of full-coverage concealers and foundations. Keep in mind that the client does not necessarily need full-coverage on their entire face, just apply extra coverage in specific areas as needed – this will keep the finished makeup application looking as natural as possible and will not feel as heavy.
Color Correct
To address the melasma, add a first layer of makeup product to the skin. Choose a full-coverage concealer color that is close to the client’s skin color, if not one shade darker. It is important not to use a color too dark (or anything close to the color of the melasma areas) since it will show through the finished look. Use this opportunity to address any other areas on the face that may need color correction like under the eyes, around the nostrils, or on the corners of the mouth. Typically, a rich, peachy-salmon based color will help neutralize those areas on most skin tones. Be sure to use a stippling brush, sponge, or clean finger in a patting motion to add coverage with precision. Using swiping motions with a bigger brush will thin out the application, exposing the melasma that needs concealing.
Even the Skin Tone
Now is the time for foundation all over the face. If the areas of concern are concealed properly, minimal product should be required at this stage. Apply a small amount to the back of the hand and use a brush or clean sponge to apply to the client’s face in soft, circular motions. Be careful not to use too much pressure or the concealer will be lifted.
Emphasize Positive Details
Complete the makeup application by adding the finishing touches and bringing out the features of the face the client loves. Draw the focus to other features on the face and diminish the look or appearance of the melasma. Add eyeshadow, eyeliner, mascara, blush, lipstick, and fill in the eyebrows. Ask the client what they would like and stay within their personal boundaries.
Since everyone is not blessed with flawless skin everyday of their lives, cosmetics can help with the rough patches. Unfortunately, hyperpigmentation and stubborn dark patches are not as easy to cover up as other imperfections. But, if the right products are used with the right applicators, the job can get done in just minutes.
And remember, melasma can fade away on its own or take a lifetime to treat. If the current treatment plan is not effective, consult with a doctor or seek local support groups. Skin care professionals are not alone in the battle to fight off melasma and other forms of hyperpigmentation.
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Amanda Azar Walsh, LME, is a professional makeup artist, medical aesthetician, and body wrapper based in South Florida. She is the founder and executive artist of Azar Beauty, lead artist for NewsmaxTV, Pelican Grand’s Pure Spa, and Studio 1 Talent Specialists. Walsh has a degree in business management from Florida Atlantic University, diplomas in fashion makeup from Cosmix School of Makeup Artistry and Paramedical Aesthetics from Southeastern College, is dual-licensed, and holds over 40 certifications. She is a member of the National Association of Professional Businesswomen, National Aesthetic Spa Network, Look Good Feel Better®, and a RAW Artist alumni.
