Melasma is one of those things nobody warns you about pregnancy, but unlike morning sickness and sore breasts, it can hang around long after the baby arrives. As in, permanently. Since I had never heard of melasma before developing it myself, let’s start with the basics. Melasma occurs when dark spots (hyperpigmentation) appear on the skin, usually due to hormones or exposure to the sun. It is often on the forehead, cheeks, upper lip, and nose, and can also appear on the body. And to be clear, melasma can definitely occur outside of pregnancy. It is only particularly common in pregnant women because hormonal fluctuations occur in the body. If this sounds like you, read on to find the best treatment for melasma.
During my first pregnancy with Phoebe, I did not develop any melasma at all. In fact, I’ve never had any problems with hyperpigmentation. But during the third trimester of my second pregnancy with Henry, I remember walking into the house after a swim and taking a double shot when I saw myself in the mirror. A noticeable brown mark appeared on my forehead within two hours. A quick google search revealed that I actually had a melasma flare-up. A conversation with my dermatologist assured me that it would most likely go away after my postpartum hormones were balanced, but that I should be extra vigilant about sunscreen.
I stopped breastfeeding a year later, and while the melasma faded it never really went away. Over the years it hasn’t bothered me too much unless I accidentally got a little too much sun and it suddenly flared up. Until I went to my derm this summer to schedule an appointment for a microneedling, and in a shocked voice she exclaimed, “Camille, what happened to your melasma ?!” I hadn’t fully realized how much the situation had gotten worse that year (most likely due to a hormonal surge when I had an IUD in the spring), but it was bad enough that she couldn’t even do my treatment out of fear that the high frequency could worsen it.
So I decided to get serious and to kick that melasma to the curb once and for all.
I spoke to Dr. Geddes-Bruce on my approach (and combined it with hours of internet research) to find out my plan. It turns out that melasma is known to be difficult to treat, but I’m happy to report: I did.
What is the Best Treatment For Melasma? Check out three of the most effective melasma treatment methods that I’ve tried and which actually worked for me.
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1. Topical Treatment Options for Melasma
A search on Sephora will reveal that there are many options when it comes to over-the-counter hyperpigmentation treatments. Some aim to stop the pigment production by melanocytes (the cause of melasma), while others fade the discoloration by lightening the skin tone. Often considered the gold standard for treating hyperpigmentation by dermatologists, hydroquinone is somewhat controversial (it’s banned in some countries, but most doctors in the US agree that research studies don’t show it is a hazard).
I invested in two products that I used on a daily basis:
Dr. Geddes-Bruce advised me to be very careful with the “spot treatment” with hydroquinone, as it also gets onto the skin around the dark spot. She said if I choose this route, look for a slight depigmented halo around the treated area. I’ve never experienced this before, but if I did the next strategy would have been to apply a thin layer of product to evenly treat my entire face.
Over-the-counter hydroquinone products are available in concentrations up to 2%. Anything higher requires a prescription. I used mine mornings and evenings after cleansing and before the oil to really let the active ingredients penetrate. I also used the lightening face oil (great for pretty much all skin types, even if not dealing with melasma) twice a day after the serum and before my moisturizer.
The judgment? Although I was skeptical that an OTC issue would make a big difference, after a few weeks I noticed that the melasma patch on my forehead was starting to lighten – I could really tell a difference, especially in photos. Still, one subtle improvement wasn’t enough for me: I wanted this bad boy to be gone. It was time for something a little more aggressive.
2. Oral treatments for melasma
I was surprised to find out about an extremely effective melasmic treatment on the US market that is taken orally. Tranexamic acid has been shown to significantly improve melasma within a month, although it should be used as a short-term therapy (and some of the reports I read online said it can come back if the patient stops taking the medication) .
I really wanted to try this miracle pill, but unfortunately tranexamic acid can slightly increase the risk of blood clots and since my IUD has the same side effects they are contraindicated.
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3. In-office treatments for melasma
Many dermatologists are wary of treating melasma in the office because any type of inflammation (i.e. laser) can make the discoloration worse. Dr. However, Geddes-Bruce informed me about an aggressive scrub that has been found to be extremely effective: the Cosmelan mask. It is specially formulated to reduce the appearance of skin discoloration caused by hormonal imbalance and photodamage (also known as sun). It’s not for the faint of heart, however, as it requires significant downtime. It turned out that the only time I was grateful was that I was quarantined at home! I signed up right away.
On the day of my treatment, I went to her office to quickly apply a mud-like mask that I had to wear for eight hours – and yes, I had to wear it on the go outside of the office and in my car at home. My children were fascinated.
That night I washed it off in the shower and then put a mask on at home every day for the next 14 days to further boost cell turnover. And boy turned these cells upside down. On the second day my skin looked sunburned and on the fourth day it started peeling … which continued for the next 10 days. It was itchy and annoying not being able to wear makeup even though I turned a corner when Dr. Geddes-Bruce told me that I could actually apply a generous amount of moisturizer (which I hadn’t noticed) Soothing Moisturizer, Milk & Honey’s Blue Tansy Balm, which felt like a soothing hug for my face and reduced irritation significantly.
On the 15th day the peeling stopped and suddenly I had the most even, glowing skin that didn’t even need makeup. My melasma was gone folks. In addition, my skin structure was smoother and looked healthier all round.
Dr. Geddes-Bruce reminded me that melasma is basically a chronic condition that requires a little maintenance to keep it in check. My plan is to treat my hydroquinone three to five days a week during the summer when it flares up and is reduced to one or two days a week during the winter months. I have no regrets and am so excited with the results but boy it was a trip – one that I hope I will never have to repeat, which is why I have become more vigilant than ever with my daily sunscreen. And on days when I’ll be in the sun, I’m never without a hat and sunglasses.
Have you dealt with melasma? I would love to hear your experiences in the comments!
Oh, and don’t think I’d let you down without an afterimage … notice the sun hat.
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This post was originally published on August 26, 2020 and has been updated since then.