Melasma

Melasma is characterized by patchy discoloration that typically appears on sun-exposed areas of the skin. The most common locations include the forehead, cheeks, nose and upper lip (forming a characteristic “mask” appearance), chin and jawline. While melasma does not cause pain, itching, or other physical discomfort, it can be a cosmetic concern for many individuals. In some cases, melasma fades on its own, especially if it was triggered by pregnancy or hormonal treatments. However, for most people, it tends to be chronic and may require ongoing treatment and sun protection.

• Hormonal Changes: Many women develop melasma during pregnancy due to increased estrogen and progesterone levels. This is why melasma is often referred to as the “mask of pregnancy.” Hormonal contraceptives and hormone replacement therapy can also trigger or worsen melasma.
• Sun Exposure & UV Radiation: Sunlight is the most significant trigger for melasma. UV rays stimulate melanocytes (the pigment-producing cells in the skin), leading to darkened patches. Even a small amount of sun exposure can worsen melasma, making daily sun protection essential.
• Genetics: A family history of melasma increases your risk of developing the condition. Some people have naturally more active melanocytes, making them more susceptible to pigmentation disorders.
• Heat & Visible Light Exposure: Not just UV rays, but also infrared radiation (heat) and blue light from screens and LED lighting can trigger melasma in some individuals.
• Certain Skincare Products & Irritants: Harsh skincare products, chemical peels, or aggressive exfoliation can irritate the skin, leading to post-inflammatory hyperpigmentation that worsens melasma.

Medical History: The team at Apex Skin Center will begin by asking about your medical history, including any symptoms you are experiencing, the duration and pattern of those symptoms, previous skin conditions or treatments, hormonal changes and any potential triggers or exacerbating factors.

Physical Examination: Board-certified dermatologist Dr. Knackstedt will conduct a thorough examination of the skin, looking for characteristic signs of melasma with the aid of magnification and specialized lighting.

Skin Biopsy (if necessary): In some cases, a skin biopsy may be performed to confirm the diagnosis of melasma and rule out other skin conditions with similar features. During a skin biopsy, a small sample of skin tissue is removed and examined under a microscope by a pathologist to look for characteristic histopathological changes consistent with melasma. In most cases of melasma, this is not necessary.

While there is no permanent cure for melasma, various treatment options can help reduce pigmentation and prevent recurrences. Dr. Knackstedt and the dermatology team at Apex Skin Center offer personalized melasma treatments based on your skin type, severity of the condition, and lifestyle factors. Here are some common treatment approaches for melasma:

Sun protection

Since UV radiation is a major trigger, daily sun protection is crucial for managing melasma.

Topical Treatments for Melasma

Prescription topical treatments can help fade melasma by targeting melanin production.

• Hydroquinone – A gold-standard skin-lightening agent that helps reduce pigment over time.
• Tretinoin & Retinoids – Promote skin cell turnover to gradually fade dark patches.
• Azelaic Acid – A gentle option that helps brighten skin and reduce hyperpigmentation.
• Vitamin C – A potent antioxidant that helps lighten dark spots and protect against UV damage.
• Kojic Acid & Tranexamic Acid – Newer skin-brightening agents that help improve stubborn melasma.

In-Office Procedures

For patients who do not respond to topical treatments alone, Apex Skin Center offers advanced dermatological treatments to help speed up melasma clearance:

• Chemical Peels – Exfoliate the top layers of skin, reducing pigment and improving skin tone.
• Microneedling – Enhances skin absorption of brightening agents and promotes collagen production.