Melasma: The Tan That Doesn’t Want To Go Away


A lot of people, particularly certain Mainers who go on vacation somewhere hot like Florida, come home with a tan, and get mad during the wintertime when that tan fades, may find the idea of a tan that doesn’t want to go away appealing.  However, you may want to think twice about contracting melasma.  Keep reading.

Melasma is an abnormal hyperpigmentation, or darkening, of the facial skin that occurs in many women.  This condition occurs commonly during times of hormonal change and particularly in pregnancy where it is referred to as “mother’s mask”.  I have seen cases associated with all types of oral contraceptives, both starting and stopping the pill.  Nobody really knows why it occurs in some women and not others, but there does appear a correlation between increases in estrogen levels making the skin more sensitive to ultraviolet light.

Melasma does not occur without UV light exposure, and appears to occur more in women who tend to tan more easily.  Melasma tends to be a blotchy darkening and tends to be symmetrical, although I have certainly seen many cases where one side was much worse than the other.  Occasionally the skin color will fade after delivery.  Unfortunately though, it does not tend to go away completely.

In the past, fading creams that contain a bleaching agent known as hydroquinone have been prescribed to combat melasma.  I personally don’t like to use this agent, as it has been banned in Europe due to concerns about association with skin cancer when used long-term.  The FDA in the U.S. is also considering banning its use here at home.

Laser treatment, on the other hand, does have a significant place in the treatment of melasma, and I have seen some amazing results from it firsthand.  The key is using a superficial laser that will not damage the underlying skin and make the discoloration worse.  This condition is known as post-inflammatory hyperpigmentation.  I use a 532 nanometer laser with settings that target the discoloration in the very superficial layers of the skin.  The color is initially darker for several days, and I always warn patients about this phenomenon.  But then, in the next 2-3 days, a light peeling of the skin occurs which lightens the area.  This is followed by a 2-3 week period of more gradual lightening which is thought to be from the body’s immune cells reabsorbing some of the damaged melanocytes deeper in the skin.  After about a month, another laser treatment is generally needed to continue lightening further and more permanently.

The number of treatments depends on the darkness of the skin, the surface area involved, and how long the darkening has been present.  Most melasma patients are satisfied with the degree of lightening they see in 3-5 treatments.  The most important preventive measure is to limit ultraviolet exposure as much as possible with daily (even on cloudy days) sunblock of at least SPF 30.  Big floppy hats and strategic sun visor usage are also helpful, as long as your skin stays out of the sun for prolonged periods of time.

If anyone you know has this problem, let them know that there are treatments.  I have had many patients who have been able to stop using heavy concealing makeup and not be self-conscious about their faces with the help of these therapies.  Give Becky a call at (207) 873-2158 to discuss further or to set up a consultation.

About Dr. John Burke

John Burke M.D. has practiced medicine for over 25 years, and is the founding partner of MidMaine Internal Medicine. He established Maine Laser Skin Care in 2004 after devoting years to learning the latest in laser and dermatologic technology. Dr. Burke has treated patients from all over the United States. He is one of Maine's busiest practitioners in laser treatments, and in the use of Botox for upper facial lines and excessive sweating.
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