Melasma

Melasma is the frustrating patches of facial hyperpigmentation often associated with hormones; this includes your natural, everyday hormones, those your body produces with pregnancy, and hormones taken for contraception. The excessive melanin pigment in these patches can reside in the top living layer of cells, called the epidermis. This is also where pigment is when you get a tan. The body sheds this pigment regularly. The bad news is that melasma pigment can also reside in the deeper layer, called the dermis. This layer does not normally hold melanin pigment, and so is one of the reasons melasma is so hard to treat.

The cause for this excess pigment production is difficult to control, compounding the challenge of treating melasma. Some aspect of it is driven by the immune system. Short treatments of strong prescription cortisone creams have been used to treat it with moderate success. However, melasma tends to recur, and topical cortisone treatment has skin thinning (and other) undesirable side effects, and thus is not a good long term solution.

For all of these reasons, the treatment of melasma is tricky, yet significant improvement is possible. Treatment needs to be both consistent and very intensive, because the pigment production and deposition of melasma is tenacious. Your treatment needs to be equally tenacious. When I create a skin care routine to treat melasma, I cover all of the bases, including:

  1. First and foremost, sun protection, which needs to be absolute and used without exception, because one “indiscretion” in the sun will set you back after you have worked so hard to lighten the patches and even the color in your complexion. Sun protection needs to be broad spectrum and used 365 days a year. I trust only the mineral zinc oxide products for this job.
  2. Skin lighteners that reduce pigment production such as retinoids (retinol and prescription tretinoin), hydroquinone (2% available without prescription and 4% or higher with prescription), botanical lighteners like kojic acid, and vitamin C are all good options. Dead cells carry pigment upwards, accentuating the uneven skin color.
  3. Exfoliators to reduce pigment carried in the dead cell layer and enhance penetration of the lightening products. I use glycolic acid for this job. Rough scrubs and sponges can be used too.

This is a very intensive treatment and sensitive skin may become irritated – which can lead to inflammation and uneven pigment production! It may be good to enlist the help of a dermatologist to treat melasma in order to get prescription-strength products. Many over-the-counter professional products, such as the ones I have here, are highly effective and yet need to be used with care. At any sign of skin irritation or inflammation, a rest needs to be taken and then treatment resumed slowly. Options are based on what you know about your skin and your skin type.

Here is how I often treat my patients:

  1. Cleanse with a Clarisonic Brush (to help products penetrate better) and a gentle cleanser or a glycolic acid cleanser. A toner will help remove any residual dirt and skin oil to enhance penetration of products as well.
  2. Correct with Pigment Fading Pads followed by either Vitamin C or Glycolic Acid. At night, use a retinoid such as a professional retinol product. Because inflammation may drive melasma, I add green tea as an ingredient to calm inflammation naturally and safely.
  3. Hydrate to balance skin moisture.
  4. Protect in the day from sun up to dusk with a good application of broad spectrum zinc oxide sunscreen. If makeup is worn, use mineral makeup to enhance sun protection.

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  1. Anti-Aging Antioxidant Kit  1001

    Anti-Aging Antioxidant Kit

    This Antioxidant Anti Aging Skin Care Kit offers the best skin care products made today to brighten skin, and help reduce wrinkles and age spots while at the same time protecting your skin from the sun and every day stresses.
    $241.70
  2. SunSavvy Kit, Sensitive Skin Protection  1014

    SunSavvy Kit, Sensitive Skin Protection

    Strong, yet non-irritating sunscreen and sun block is essential for people with sensitive skin.

    $38.50
  3. SunSavvy Kit, Ultimate Protection  1015

    SunSavvy Kit, Ultimate Protection

    The Ultimate Sun Protection Kit provides everything you'll need to protect your skin from the sun's harmful rays.

    $52.50
  4. Raw Elements SPF 30 Sunscreen Eco Stick  1078

    Raw Elements SPF 30 Sunscreen Eco Stick

    At last, the best mineral zinc oxide sunscreen product proven not to run into and sting your eyes - even when you're wet!
    $16.00
  5. Raw Elements Eco Formula SPF 30+ Sunscreen  1128

    Raw Elements Eco Formula SPF 30+ Sunscreen

    The best all natural, UVA-UVB broad spectrum, high performance sun screen for your 'wet and sweaty activities'.
    $19.00
  6. Loose Mineral Makeup Blush™  1212

    Loose Mineral Makeup Blush™

    Two lovely, soft shades to invoke a natural looking, delicate health-radiating glow to your skin (without the sun!).

    $17.00
  7. Anti-Aging Antioxidant Kit - Max Strength - Glytone Exfoliating Lotion #3 for Oily Skin  1055
  8. Baked Mineral Powder™  1209

    Baked Mineral Powder™

    Hydrating mineral powder for a luminous, velvety finish to your skin.

    $30.00
  9. Retinol Ultra-Intensive Anti-Wrinkle Night Cream™  1182

    Retinol Ultra-Intensive Anti-Wrinkle Night Cream™

    Ultra-high concentration retinol is one of the best non-prescription skin care ingredients to fight skin aging.
    $84.00
  10. Ultimate Acne Solutions Skin Care Kit™  1010

    Ultimate Acne Solutions Skin Care Kit™

    Most regular acne products are irritating to sensitive skin, but this acne treatment kit delivers the best acne medications at levels that are appropriate for sensitive skin.

    $41.40
  11. Solbar Zinc SPF 38 Sunscreen  1018

    Solbar Zinc SPF 38 Sunscreen

    My favorite sunscreen for sports, swimming and sweaty activities. It spreads so easily that it's also my favorite product to apply to the large expanses of unprotected skin on our bodies. You absolutely must use a water resistant sunscreen when you're going to be wet. Solbar Zinc provides protection for up to 80 minutes in the water with its hefty 7.5% mineral zinc oxide combined with other chemical sunscreen agents. Oil free and shouldn't aggravate acne.

    $13.00
  12. Women's Sun Protection Bucket Hats  1250

    Women's Sun Protection Bucket Hats

    Lightweight, cool, and breathable cloth UPF 50 sun protection hats. Get in the habit of wearing this broad−brimmed hat along with your broad spectrum sunscreen − proven effective in the prevention of skin cancer and premature aging. Fits your head perfectly with its clever, adjustable inner brim cord. Highly packable too and makes a great gift!
    $20.00
  13. Sheer Strength Pure Physical Tinted Matte Sunscreen, SPF 50™  1217

    Sheer Strength Pure Physical Tinted Matte Sunscreen, SPF 50™

    Oil-free and oil control ultra-light and tinted matte technology in a hypoallergenic sunscreen – it’s the holy grail for oily and sensitive skin AND it’s elegant for all skin types too!

    $43.00
  14. Clarisonic Brush Replacement Heads  1219

    Clarisonic Brush Replacement Heads

    Get the most out of your Clarisonic Cleansing System by keeping your Clarisonic Brushes in top shape.  Clarisonic recommends that you replace your brush head every 3 months to get the best results from your beloved Clarisonic Skin Cleansing System. Pick the right brush for your skin type to fully customize how the system works for you.

    $25.00
  15. Ultimate Acne Solutions Skin Care Kit, Extra Strength™  1011

    Ultimate Acne Solutions Skin Care Kit, Extra Strength™

    Tolerant skin benefits from the high concentration of acne medicine in the Ultimate Acne Solutions Skin Care Kit, Extra Strength.

    $48.00
  16. Loose Mineral Makeup Powder Foundation™  1213

    Loose Mineral Makeup Powder Foundation™

    This gossamer-light triple milled powder gives you a soft and lovely matte finish with complete coverage.

    $20.00
  17. Facial Redness Relief Kit - with Resveratrol™  1069

    Facial Redness Relief Kit - with Resveratrol™

    This is the same magical ingredient combination as my Facial Redness Relief Kit - Oil Free but now with the newest Green Tea Skin Therapy Cream containing resveratrol, the powerful grape antioxidant, in a paraben-free cream base.

    $80.00
  18. Glytone Exfoliating Lotion #2  1026

    Glytone Exfoliating Lotion #2

    AHA therapy with a light water base for oily skin. I have patients use it to improve acne and rejuvenate skin.

    $32.00
  19. Salicylic and Glycolic Acid Acne Treatment Pads™  1035

    Salicylic and Glycolic Acid Acne Treatment Pads™

    2% Glycolic Acid and 2% Salicylic Acid acne treatment medicines are strong enough to treat stubborn acne but gentle on sensitive skin.

    $17.40
  20. Glytone Exfoliating Lotion #3  1027

    Glytone Exfoliating Lotion #3

    The same light water base for oily skin as in the Glytone Exfoliation Lotion #2 but with a stronger level of AHA therapy. I have patients use it to improve acne and rejuvenate skin. I recommend conditioning the skin by beginning with Lotion #2 and then advancing to #3.

    $34.00
  21. Replenix Exfoliating Scrub  1024

    Replenix Exfoliating Scrub

    The rolled bamboo beads provide gentle but effective physical facial exfoliation. Used twice a week in the morning, this product brightens and gives facial skin a nice luster.

    $36.00
  22. Glytone Mild Gel Wash  1025

    Glytone Mild Gel Wash

    This is an excellent exfoliating foaming cleanser that preps the skin for glycolic acid creams and lotions. It's an excellent cleanser for acne treatment or to exfoliate as part of an anti aging skin care regimen.

    $28.00
  23. Sheer Strength Pure Physical Spray Sunscreen SPF 50+™  1207

    Sheer Strength Pure Physical Spray Sunscreen SPF 50+™

    At last, an ultra-light sunscreen spray that’s pure mineral protection with micro (not nano) zinc oxide for the best anti-aging broad spectrum protection. 

    $38.00
  24. Naturally Hydrating Pore-Minimizing Facial Toner™  1215

    Naturally Hydrating Pore-Minimizing Facial Toner™

    Brighten your complexion with the extra clean that comes from using a gentle and non-drying toner after washing your facial skin.  

    $28.00
  25. Foaming Acne Treatment Cleanser™  1033

    Foaming Acne Treatment Cleanser™

    Our Dr. Bailey SKIN Oil Off Cleanser, formulated for sensitive skin types. This 2% Glycolic Acid/2% Salicylic Acid foaming cleanser is strong enough to remove oil and debris from clogged pores while remaining gentle enough for most sensitive skin.

    $14.50
  26. Glytone Facial Cream #3  1029

    Glytone Facial Cream #3

    This rich hydrating face cream is perfect for people with dry skin that have used lower strength glycolic acid products and are now ready to move up to the strongest level.
    $42.00
  27. Anti-Aging Antioxidant Kit - Max Strength - Glytone Facial Cream #3 for Dry Skin  1004

    Anti-Aging Antioxidant Kit - Max Strength - Glytone Facial Cream #3 for Dry Skin

    Enjoy the maximum benefits of glycolic acid to brighten your skin and treat age spots using Glytone Facial Cream 3 with the highest level of glycolic acid that I recommend for home use plus my Antioxidant Anti-Aging Skin Care Kit. Use Glytone Facial Cream 3 for dry skin and the best antioxidant anti-aging skin care products made. Have confidence that you're using the best products that skin care science has to offer!

    $283.70
  28. Advanced Corrective Eye Cream™  1059

    Advanced Corrective Eye Cream™

    6-in-1 technology to fight all eye-area problems in one cream!

    $75.00
  29. Salicylic and Glycolic Acid Acne Treatment Pads, Extra Strength™  1036

    Salicylic and Glycolic Acid Acne Treatment Pads, Extra Strength™

    Tolerant skin benefits from 10% glycolic acid, which I think is the ideal concentration to loosen black heads. These medicated pads perform this feat while lifting oil and debris from the skin.

    $20.00
  30. Foaming Acne Treatment Cleanser, Extra Strength™  1034

    Foaming Acne Treatment Cleanser, Extra Strength™

    This extremely strong 10% Glycolic Acid/2% Salicylic Acid foaming cleanser is the strongest acne cleanser I recommend. Regular use dissolves oil and black heads. It's ideal for tolerant skin.

    $18.00
  31. Glycolix Elite SPF 30 Sunscreen  1016

    Glycolix Elite SPF 30 Sunscreen

    This is the ultimate in 'nonchemical', mineral, physical sun protection. It is perfect for people with extremely sensitive skin.

    $25.50
  32. MDSolarSciences Mineral Tinted Creme SPF 30 Broad Spectrum  1157

    MDSolarSciences Mineral Tinted Creme SPF 30 Broad Spectrum

    Luxurious, Broad Spectrum Sunscreen with a Silky "Barely There" Finish.
    $32.00
  33. Daily Moisturizing Face Cream for Oily to Normal Skin™  1139

    Daily Moisturizing Face Cream for Oily to Normal Skin™

    Gentle, oil free hydration for facial skin. This light glycerin moisturizer is perfect for acne prone skin and to use in combination with all of our therapeutic facial products.

    $16.50
  34. Citrix Sunscreen SPF 40  1017

    Citrix Sunscreen SPF 40

    My favorite every day sunscreen! I wear it every day on my face, neck and chest! It gives a great matte finish that's SPF 40 and water resistant for up to 80 minutes.

    $25.00
  35. Green Tea Antioxidant Skin Therapy™  1060

    Green Tea Antioxidant Skin Therapy™

    State of the art antioxidant skin care powerhouse and my absolute favorite facial product. If you were going to pick just one antioxidant for your skin care, the best would be green tea - it helps calm skin redness and fights sun damage.

    $70.00
  36. EltaMD UV SPF 46 Sunscreen  1125

    EltaMD UV SPF 46 Sunscreen

    Completely oil free and ultra light feel on the skin make this sunscreen a marvel. Perfect for oily to normal and acne prone skin. Comes with either a clear or tinted option to help soften complexion flaws for all skin types.

    $32.00
  37. EltaMD UV Daily SPF 40  1126

    EltaMD UV Daily SPF 40

    Broad spectrum UVA and UVB protection in a lovely moisturizing lotion that's sheer and elegant of the skin.
    $24.00
  38. Glytone Facial Cream #2  1028

    Glytone Facial Cream #2

    An extremely hydrating glycolic acid cream. It's a perfect starting point for beginning AHA therapy for dry skin types. 

    $40.00
  39. Suntegrity Baby Natural Mineral Sunscreen Broad Spectrum SPF 30  1127

    Suntegrity Baby Natural Mineral Sunscreen Broad Spectrum SPF 30

    Non-greasy natural non-nano zinc oxide mineral sunscreen for every day sun protection. This is a lovely natural mineral sunscreen made with organic ingredients - and it's not just for babies!

    $24.00
  40. All Natural Face and Body Butter Cream™  1140

    All Natural Face and Body Butter Cream™

    Highly Effective moisturizer to heal your extremely dry and sensitive skin.
    $24.00
  41. Pressed Mineral Makeup Powder™  1216

    Pressed Mineral Makeup Powder™

    Oil-free pressed minerals give you medium to full coverage with a smooth, long-lasting matte finish. This mineral makeup foundation is full coverage, yet oil-free. The light reflecting powder is so fine that it won't flake or cake. You get a natural, healthy skin look because the tiny mineral particles are so fine that they layer imperceptibly on your skin giving you complete coverage to show off your skin.

    $24.00
  42. Daily Moisturizing Face Cream for Dry to Normal Skin™  1056

    Daily Moisturizing Face Cream for Dry to Normal Skin™

    Richly moisturizing, non-greasy technology with just a hint of hydrating oils to balance dry facial skin. Fortified with antioxidants, vitamin E and CoQ10.
    $18.00
  43. Instantly Luminous Multi-Action Serum™  1211

    Instantly Luminous Multi-Action Serum™

    Advanced skin care technology for firmer, brighter, and smoother skin instantly!

    $69.00
  44. Naturally Best Bar Soap for Dry Skin™  1155

    Naturally Best Bar Soap for Dry Skin™

    Unscented, glycerin-rich soap made with healing oats for your dry and sensitive skin.
    $5.00
  45. Retinol Intensive Anti-Wrinkle Night Cream™  1183

    Retinol Intensive Anti-Wrinkle Night Cream™

    Retinol is one of the best non-prescription skin care ingredients you can use to reverse the signs of skin aging. Every serious anti-aging skin care routine should include a retinoid product.

    $73.50
  46. Replenix CF Cream   1022

    Replenix CF Cream

    This has been a popular facial product in my dermatology practice for years! This unique oil free cream contains a high concentration of green tea antioxidant polyphenol, combined with caffeine and hyaluronic acid (a very expensive protein moisturizing ingredient).

    $69.70
  47. Vitamin C Anti-Wrinkle Professional Treatment Serum™  1023

    Vitamin C Anti-Wrinkle Professional Treatment Serum™

    I think this is the best vitamin C skin care product made!  Dermatologists and skin care experts agree that vitamin C is one of the most important products in a serious anti-wrinkle treatment for sun-damaged skin.

    $111.00
  48. Calming Zinc Bar Soap®  1044

    Calming Zinc Bar Soap®

    My favorite skin cleanser! Naturally healing, unbelievably hydrating, and powerfully medicated to solve your skin problems.

  49. Vanicream Moisturizing Skin Cream, 4 oz.  1085

    Vanicream Moisturizing Skin Cream, 4 oz.

    Dermatologist recommended skin cream for sensitive skin. One of the best skin care products to heal dry skin for people with eczema or skin allergies.
    $8.00
  50. All Natural Face, Hand and Body Lotion™  1141

    All Natural Face, Hand and Body Lotion™

    Elegant and light-textured, natural moisturizer for dry to normal sensitive skin.
    $20.00
  51. Vanicream Cleansing Bar  1156

    Vanicream Cleansing Bar

    Dermatologist-recommended hypoallergenic cleansing bar for extremely sensitive skin.
    $4.00
  52. EltaMD UV Lip Balm Broad-Spectrum SPF 31  1158

    EltaMD UV Lip Balm Broad-Spectrum SPF 31

    Protect your delicate lips from the sun every day with a sunscreen lip balm you will love to use.
    $10.00
  53. Suntegrity 5-in-1 BB Cream SPF 30 Tinted Moisturizing Facial Sunscreen  1208

    Suntegrity 5-in-1 BB Cream SPF 30 Tinted Moisturizing Facial Sunscreen

    This luscious and all natural face cream is my absolute new favorite face sunscreen! Natural, broad-spectrum mineral zinc oxide protection that feels and looks so good on your skin that you'll want to wear it 24/7.

    $45.00
  54. Clarisonic Mia 2   1252

    Clarisonic Mia 2

    Patented sonic skin cleansing for your face to 'bump-up' the effectiveness of your skin care regimen. Clarisonic Mia 2 gives you a gentle and effective cleanse at home or on the go.

    $150.00
  55. Men’s Performance Microfiber Hat  1189

    Men’s Performance Microfiber Hat

    These stylish and high-performance men’s microfiber hats have a breathable mesh lining and a 3 1/2" brim. They fit perfectly and won’t blow off because they have both an adjustable chin strap and an adjustable brim strap to hold them securely to your head.
    $18.00
  56. Vanicream Free & Clear Conditioner  1257

    Vanicream Free & Clear Conditioner

    Dermatologist-recommended hypoallergenic conditioner for extremely sensitive skin, eczema and skin allergies. Non-medicated, preservative and gluten-free conditioner that leaves hair feeling clean and healthy. Great for the entire family. 

    $13.50
  57. Pigment Fading Pads  1253

    Pigment Fading Pads

    Pigmented skin? This 2% hydroquinone treatment can help. 

    $66.50
  58. Clarisonic SMART Profile   1251

    Clarisonic SMART Profile

    Luxurious head-to-toe sonic face and body cleansing brush. Patented sonic skin cleansing for your face and body to 'bump-up' the effectiveness of your skin care regimen. 11x better cleansing than hands alone!

    $265.00
  59. Glycolic Acid Anti-Wrinkle Face Cream  1254

    Glycolic Acid Anti-Wrinkle Face Cream

    The perfect AHA face cream for normal and combination skin.
    $28.00
  60. Holiday Kit for Facial Redness Relief  1261

    Holiday Kit for Facial Redness Relief

    This is the same magical ingredient combination as my regular Facial Redness Relief Kit but now with the newest Replenix Cream containing resveratrol, the grape antioxidant, in a new paraben free cream base.

    $68.00
  61. Vanicream Free & Clear Shampoo  1256

    Vanicream Free & Clear Shampoo

    Dermatologist-recommended hypoallergenic shampoo for extremely sensitive skin, eczema and skin allergies. Non-medicated, preservative and gluten-free shampoo that leaves hair clean and manageable. 

    $10.00

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