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What are the Best Products and Ingredients for Melasma?

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Melasma is a common skin problem, affecting women commonly during pregnancy, puberty, menopause, and other times of significant hormonal change (AAD). This makes sense, given that melasma production has been linked to an upset in the body’s balance between estrogen and progesterone (source). It has also been linked with high cortisol production. Another thing to note: 10% of melasma patients are men, so keep that in mind.

Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck.

I used to have sunspots as young as age 19, but then I started using [easyazon_link identifier=”B001CJJ5SQ” locale=”US” tag=”cosmeticswiki-20″]Skinceuticals[/easyazon_link] CE Ferulic, with 15% L-ascorbic acid and 1% vitamin E, and my sun spots gradually faded over the course of a year. At the time, I was studying pre-med with the intention of becoming a pediatric cardiologist. Between the fact I could not deal well emotionally with children being so sick, and the realization that there was actual science behind the active ingredients in skin care, I switched over to dermatology. I now make my own FutureDerm Vitamin CE Caffeic Serum in the lab with 16% microencapsulated vitamin C and 2% vitamin E, and my skin has never been better. To say that I’m passionate about treating melasma and hyperpigmentation is an understatement!

So, without further ado, here is how this works:

How Does Melasma Occur?

Melasma form from an excess of a compound called melanin, which is a type of skin pigment. It looks rather brown, like a hazelnut coffee. The resultant melasma can look brown or gray.

All sorts of stimuli can cause melanin synthesis, mostly “stressors,” things like pollution and stress. (Yes, your bad boss could be causing you to form sunspots). The biggest culprit, however, is UV light. The sunlight will cause a cascade, or sequence, of steps that trigger melanin production (Mutation Research, 2005; Pigment Cell Research, 1992).

How is Hyperpigmentation Treated?

There are three primary ways to treat hyperpigmentation at home.

Treatment #1: Exfoliate.

The first is to exfoliate the uppermost layer of the skin, which is known as the epidermis. You can do this with mechanical exfoliation, meaning scrubs or microedermabrasion. (I personally love Clinique 7-Day Scrub, $18.77, which is gentle enough for most skin types). However, you can also do this with chemical exfoliation, meaning retinoids, glycolic acid, or salicyclic acid. I honestly prefer this method, because each of these ingredients provide other benefits in addition to exfoliation. For instance, retinoids have been shown in research by Fisher et. al to prevent and treat collagen loss with regular use over time. And glycolic acid has hydrating effects (yes, acids can be hydrating)!

The higher the strength, or concentration, of retinoids or glycolic acid, the more exfoliation you will get. Retinoids over-the-counter are available as low as 0.025% and as high as 2.0%. A tolerable strength 1-3 times a week for most skin types is 0.5%, like our FutureDerm Time-Release Retinol 0.5. On the other hand, glycolic acid over-the-counter is available in concentrations from 5-20%. A tolerate strength is generally around 15%, like Dr. Dennis Gross Alpha Beta Extra Strength Peel Pads.

Treatment #2: Break down melanin that already exists.

The second way to treat hyperpigmentation is with ingredients that are shown in independent studies to break down melanin that has already been formed within the skin. Ingredients that work in this way include vitamin C as L-ascorbic acid (International Journal of Pharmaceutics) and hydroquinone (Journal of Investigative Dermatology, 1984). Interestingly enough, both vitamin C and hydroquinone also prevent new melanin from forming (see #3, below). Vitamin C is more gentle and does not have as many potential side effects as hydroquinone, but in a side-by-side comparison study, hydroquinone was proven to be more effective in treating hyperpigmentation than vitamin C (International Journal of Dermatology). So that’s your call. Below, I break down more facts:

Vitamin C simply breaks down melanin it encounters within the skin somewhat (International Journal of Pharmaceutics). However, this is a mild effect that takes months, if not years, to produce results. When I had visible sunspots at age 19, it literally took daily use of a 15% vitamin C serum for three months to fade noticeably, and an entire year for them to be gone completely. For best effects, keep in mind vitamin C works best when paired with vitamin E. As longtime readers of the FutureDerm blog know, vitamin C and vitamin E are network antioxidants that enhance the power of one another (Cosmetic Dermatology, 2012). When vitamin C is depleted, it can essentially “borrow” an electron from vitamin E to renew itself, and vice versa. I, of course, love my FutureDerm Vitamin CE Caffeic 16+2 Serum with 16% microencapsulated vitamin C and 2% vitamin E, but I also approve of [easyazon_link identifier=”B001CJJ5SQ” locale=”US” tag=”cosmeticswiki-20″]Skinceuticals[/easyazon_link] CE Ferulic.

On the other hand, hydroquinone causes cytotoxicity (or cell death) in melanocytes, the cells that produce melanin. This effect prevents new melanin from forming as well as breaking down melanin itself.

Unfortunately, this effect has been associated with the development of ochronosis, which is a rare darkening of the skin that occurs in less than 2% of people who use hydroquinone. For this reason, the European Union has restricted use of hydroquinone (Journal of the American Academy of Dermatology, 2006), and some dermatologists avoid recommending it to patients altogether. In general, I recommend it with careful use and regular monitoring of the skin, especially if you have a darker skin tone, making you more susceptible to the condition. That said, I do find that Ambi Fade Cream ($9.15, Amazon.com) works fairly well, more as an on-the-spot serum than anything else.

Treatment #3: Prevent new melanin from forming.

The third way to treat hyperpigmentation is with ingredients that are shown in independent studies to inhibit melanin from forming. These include kojic acid (Cosmetic Dermatology, 2012), the peptide LumixylTM (Journal of Drugs in Dermatology, 2009), resorcinol (also known as SymWhite), and again vitamin C and hydroquinone.All of these hyperpigmentation-preventing treatments work in the same way: that is, by inhibiting an enzyme, tyrosinase, from working. Tyrosinase is an essential enzyme in melanin production. When you inhibit it, or prevent it from working, melanin cannot form at the same rate or quantity, if at all. Granted, these ingredients prevent tyrosinase in different ways — kojic acid inhibits catecholase activity of tyrosinase, hydroquinone induces cytotoxicity (cell death) in melanocytes – but the overall effect is the same.

What is a great regimen to treat and prevent melasma?

To be able to 1.) exfoliate skin, 2.) break down existing melanin, and 3.) prevent new melanin from forming, I recommend the following regimen:

Step 1. Cleanse and Exfoliate, Morning and Night.

You can cleanse and exfoliate in one step with a salicyclic acid cleanser, like . Or you can cleanse with a hydrating cleanser and then exfoliate with a scrub like Clinique 7-Day Scrub. I prefer the latter method, because when my skin is a little drier, I can skip this step completely. (Plus, I get to use my own cleanser, but that’s beside the point).

Step 2. Use a Concentrated Vitamin CE Serum under Sunscreen Each Morning.

Next, use a concentrated vitamin C and E serum under a broad-spectrum UVA/UVB sunscreen with an SPF of at least 30 and preferably zinc oxide (zinc oxide blocks more UVA rays than titanium oxide). I like our FutureDerm Vitamin CE Caffeic Silk Serum 16+2, followed by our sunscreen, which is not yet available. (We’re looking at April or May, stay tuned!)

Step 3. Use a Concentrated On-the-Spot Kojic Acid + Hydroquinone Treatment Each Evening.

Porcelain Skin Skin Whitening Serum doesn’t have great packaging or a recognizable brand name. But what it does have is ingredients.  As an on-the-spot treatment, the combination of melanin-degrading hydroquinone (2%) and preventing kojic acid is potent enough to create some exciting results. Granted, it does also contain vitamin C, but it is in such low concentration, I would not consider it much of a benefit. Similarly, the licorice and mulberry extract may have very mild hyperpigmentation-fighting ability, but it’s really the hydroquinone and the kojic acid providing the benefit here.

Step 4. Follow with a Retinoid Serum.

Retinol in at least a concentration 0f 0.5% has been shown in peer-reviewed independent studies to have many effects, including exfoliation (which helps reduce the appearance of age spots over time). But retinol also has been associated with an increase in collagen production over time, meaning a reduced appearance of wrinkles and fine lines. Who wouldn’t want that? So I definitely recommend our FutureDerm Time-Release Retinol 0.5 as a part of your hyperpigmentation regimen.

Step 5. Use a moisturizer with Lumixyl and/or Hydrators.

Unfortunately, as you may have noticed, many of the treatments used to treat hyperpigmentation can also be a bit drying. For this reason, I recommend Lumixyl moisturizer only for those with oily skin, which tends to be a little more resistant, and hydrators like hyaluronic acid and fatty acids for those with dry or normal skin. I like our FutureDerm Customizable Moisturizer – be sure to mention in the Comments that you are using it with other hyperpigmentation-fighting treatments so we can adjust the ingredients for you!

Step 6. Once per week, use Glycolic Acid Instead of Retinoids.

Once per week, skip the retinoid and use a glycolic acid instead. I like Dr. Dennis Gross Alpha Beta Extra Strength Peel Pads.

I don’t use retinoids and glycolic acid together because retinol activation within the skin occurs at a neutral pH, whereas glycolic acid is — you know it — acidic. So I definitely stick to retinoids most nights and glycolic acid just once each week.

Bottom Line

To treat hyperpigmentation, you need to exfoliate, break down melanin, and prevent new melanin from forming. Using our regimen, you should be able to get there!

What are your thoughts on this post? Let us know in Comments!

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Nicki Zevola is the founder and editor-in-chief of FutureDerm.com. Named one of the top 30 beauty bloggers in the world by Konector.com since 2009, Nicki

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