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Many women are embarrassed and distressed by brown or grayish-brown patches on their faces, a common condition known as melasma. The condition, which affects about 5 to 6 million women annually, is benign, but difficult to treat. This past summer, the U.S. Food and Drug Administration approved a breakthrough treatment, the Fraxel™ laser, for the treatment of melasma.
Many women are embarrassed and distressed by brown or grayish-brown patches on their faces, a common condition known as melasma or the “mask of pregnancy.”
The condition, which affects about 5 to 6 million women annually, is benign, but difficult to treat. “Melasma is linked to hormonal changes that occur during pregnancy and when using birth-control pills, and is worsened by sun exposure,” according to Joshua Fox, MD, a leading dermatologist and founder of Advanced Dermatology and The Center for Laser and Cosmetic Surgery. Until recently, bleaching creams and other types of topical medications were the best hope for lightening the unsightly patches, but these products can take a long time to clear brown spots and don’t always work very well.
Now, there is a much better option particulary in cases unresponsive to cream. This past summer, the U.S. Food and Drug Administration approved a breakthrough treatment, the Fraxel™ laser, for the treatment of melasma. “With the Fraxel laser, we can gently treat portions of the skin and penetrate deeply enough to eliminate the pigment-producing cells or melanocytes that cause melasma,” says Dr. Fox. “There may be a little redness and swelling after the treatment, but it typically fades within a day or two and can be covered with makeup.” Three to five treatments spaced about a month apart may be required – some doctors do it on a weekly protocol. Each treatment takes about 30 minutes, but you should expect to be in the doctor’s office for over an hour, as a topical anesthetic needs to be applied and take effect before the laser is used.
Fraxel’s technology works on skin in much the same way a computer artist might manipulate a digital photograph. Just as the artist corrects “pixel by pixel” in a photograph, the laser works cell by cell on the skin. “Fraxel corrects a section of cells, called Micro Thermal Zones (MTZ), rather than the entire surface,” Dr. Fox explains. “This allows the healthy surrounding cells to promote faster healing to the entire area.” What’s more, Fraxel treatments are applied deeply into the skin, encouraging regeneration at the collagen level. “This is where we see the real benefits of the Fraxel laser treatment, in that it aids in the natural regrowth of healthier, younger-looking skin cells,” he adds. This is why it is also helpful for wrinkles, scars, phototherapy and many other problems.
In one study, improvement was seen in 7 of 10 women with melasma who received Fraxel treatment; in another that compared Fraxel treatment plus use of topical creams to topical products alone, significantly more fading of brown patches was seen with the laser. No serious adverse events were reported in either study. The Fraxel laser has also been approved by the FDA to treat wrinkles, fine lines, and other age-related changes on the body and face. However it is the first and only laser approved by the FDA for hte treatement of Melasma.
Other Treatment Options
A triple combination treatment called Tri-Luma cream, containing tretinoin (a vitamin A derivative often used to treat acne and wrinkles), hydroquinone (a bleaching cream), and fluccinolone acetaonide (cortisone) is also effective for melasma. Other compounds hydroquinone and vitamin C, HQ alone, HQ and AHA, Azalaic Acid or Kojic Acid can also be utilizied. Studies show it clears or almost clears melasma in 70% of patients who apply it nightly for 8 weeks or more. Side effects include redness, peeling, and dry skin.
Chemical peels and microdermabrasion, both of which exfoliate the outer layer of skin, may also be prescribed to treat melasma, but their results are inconsistent. “Whatever treatment you have, it is critical to use sunscreen regularly and avoid sun exposure, or melasma may return,” says Dr. Fox.
Who Gets Melasma?
Melasma occurs as the result of increased production of melanin, the substance our bodies make that gives color to the skin and hair. It affects women of all races (and a few men), but is more common among those with darker skin. It also runs in families. Typically the brown patches appear most commonly on the cheeks, upper lip, nose, chin, or forehead. They may sometimes fade on their own after pregnancy or stopping birth-control pills but often recur with subsequent pregnancy or use of the pill.