One of the most bothersome facial pigment problems is called melasma - otherwise known as "pregnancy mask. Melasma is a brownish pigmentation that affects adult women. It often develops during pregnancy - hence the name "pregnancy mask". Some women only have a few small brown spots here and there, but many have big patches of brown pigment that cover entire cheeks or foreheads or around the mouth. It can often be difficult to cover completely with makeup, and many women have spent a fortune on lightening creams and various laser therapies trying to get rid of it. Melasma is exacerbated by sun and UV radiation exposure (including tanning beds), but hormonal factors play a role as well, since it often comes on during pregnancy, while on birth control pills, or while on hormone replacement therapy. Certain unknown genetic factors will also predispose certain women to get it. Melasma can be very difficult but not impossible to control. Here are some tips:
1. Use daily sunscreen. The best method of treatment is prevention. Starting at a young age with daily sun block, avoiding intense sun exposure, and avoiding tanning beds all can help prevent younger women and teenagers from developing this condition in their middle adult years. In women that have melasma already, sun protection can keep it from worsening. This means daily sun block year round.
2. Stop your birth control pills if you no longer need them for birth control. If you are finished having kids, consider your surgical options for birth control. If you are taking birth control for help with menstrual symptoms, consider bioidentical hormone management instead. If you are taking hormone replacement therapy, try to minimize your estrogen (take the smallest amount you need to control your symptoms)
3. Avoid soy. Many people don't know that 20% of the calories in the typical American diet come from soy derivatives. Much of our processed food contains significant amounts of soy. And soy can mimic estrogen in your body and may exacerbate melasma. Read your food labels, and try to cut back on your soy intake.
4. Lightening creams. This is a very popular form of treatment but not effective for many and usually will only lighten the melasma some. Hydroquinone is the most effective topical lightening agent and can be found in low doses over the counter or at higher more effective doses with a prescription. But long term use of hydroquinone can sometimes exacerbate the melasma, especially in Asian and Hispanic skin. Therefore, short-term intermittent use is best. Triluma (which contains hydroquinone), Retin A, and Kojic Acid are other topical lighteners that may help.
5. Chemical Peels. A series of medical grade chemical peels with glycolic acid or TCA can help some people with melasma.
6. Laser therapy can be especially effective at treating melasma, but you need to chose the correct type of laser. Traditional photofacials or micro laser peels typically do not go deep enough to remove melasma pigment in most people. The more aggressive fractionated laser therapy (such as the Active FX laser) offer more consistent melasma-removing results.