The miasma of melasma
July 8, 2014 7:11 AM   Subscribe

Several months ago I started developing melisma (darkening of the skin on my upper lip). As I am a female who does not necessarily wish to be doing a Charlie Chaplin impersonation at all times, what, if anything, can be done about this?

Possibly relevant details:
I'm not pregnant
I'm not on hormonal birth control, nor have I been for years
I wear sunblock and a hat more or less religiously (ironically, the melisma first made its appearance at around the same time I started wearing daily facial sunblock)
I do not have PCOS, that I'm aware of
Am in the somewhat normal-to-stressed range of things (I tend towards insomnia and anxiety)
I am very pale--the melisma is very noticeable

Are there any treatments that really truly work for getting rid of it? Or, barring that, any ways that I can cover it up? I am a non-makeup-wearing sort, so would be starting from scratch, here.

I've been using a Neutrogena dark spot remover nightly for weeks now, and I don't think it's done a darn thing.

I am willing to try things ranging from the woo to the peer-reviewed. If I'm going to go to the headache and expense of going to a dermatologist and/or makeup counter, though, would like to have an idea of what I'm getting into.

posted by whistle pig to Health & Fitness (18 answers total) 9 users marked this as a favorite
Has a doctor confirmed what it is? I had a spot (on my lower lip) that my dermatologist just froze because it turned out to be skin cancer. :( Perhaps my spot looked totally different than your spot, but I would recommend having a dermatologist check it out...a regular doctor had previously and incorrectly told me it was nothing. A simple freeze of the spot made it scab up and then disappear completely in my case.
posted by three_red_balloons at 7:22 AM on July 8, 2014

Chances are high that someone you talk to will bring up laser treatment, eg. CO2 laser resurfacing. Please research it very thoroughly before you go that route because I have done it and ended up with worse brown patches than I ever had before. While promising initially, the treatment made my skin substantially more sensitive to the sun and despite religious sunblock application and hats, and despite repeated treatments (I had three in all, six months apart), I am now forced to use heavy foundation to hide the brown patches which cover my forehead and the tops of my cheeks, where the laser was most heavily applied. I've concluded it only makes sense if you can be absolutely certain that you will never see sunlight after treatment. Online reviews rarely tell you what the results look like two years later. In my case, they just got worse and worse and worse.
posted by Dragonness at 7:27 AM on July 8, 2014 [1 favorite]

If you do end up using makeup, I can recommend Revlon's ColorStay foundation as providing good coverage and holding up very well throughout the day. You might be able to use some just on that area and then blend -- when I don't feel like doing my whole face I just dab a little on as concealer where needed.
posted by Jacqueline at 7:36 AM on July 8, 2014 [2 favorites]

I had the exact same thing - this took a while to work (about 12 weeks) but it really did work well:

Rapid Age Spot and Pigment Lightening Serum

This is the same thing, but with acne-fighting compounds:

Post-Acne Spot Lightening Gel

Of course, the Neutrogena might still work, if you give it enough time.
posted by lilboo at 7:38 AM on July 8, 2014 [2 favorites]

I also had this - it lasted as long as I was on hormonal birth control. I went to the dermatologist and she suggested I try Clinique's Dark Spot Corrector. She said that hydroquinone was the tried-and-trued method, but there were other health concerns, and it was prescription only. Now, the clinique corrector unfortunately didn't work for me (just use a thin layer twice a day), but I thought I'd throw it out there, in case it works for you. She said it could take weeks to clear up, but she had seen really good results with her other patients, to the point where she was rarely writing prescriptions for this any longer. Good luck!
posted by umwhat at 8:14 AM on July 8, 2014

FWIW, I have melasma on my forehead and on my back which appeared around April last year. I asked two dermatologists about it (mainly about why it showed up and what to expect) and they both advised against any sort of treatment. Both said to use a strong, broad-spectrum sunblock and keep out of the sun and that it would fade away on its own a bit this way. After all, the cause is hormonal and it takes a long time for our bodies to level out. Like in your case, there were no outside factors why my hormone levels would change.

I was prescribed a moisturizer with azelaic acid for other reasons, but azelaic acid is a common treatment for melasma as well. The azelaic acid took a while to get used to as it stings/itches at first. To me there is no visible difference between last year when it fist appeared and this year in terms of coloration or size. But I used that moisturizer for only 3 months maybe. So now, I still have melasma, I don't camouflage it, I don't put heavy sunblock on it but I also don't sit in the sun for ages. I have made my peace with it.

Specifically asked about chemical peels and laser treatments, both dermatologists were very skeptical, saying it's not worth trying as the dark pigments penetrate the skin fairly deep and it would take an invasive procedure with unknown outcome to attempt to treat it. Those harsher treatments really mean that you can't go to work or even outside for over a week and have to let the raw skin heal. Then it's strict avoidance of sun for a long time. Usually those treatments are scheduled in the fall/winter when there is naturally less sun.

In your shoes, I'd see a dermatologist just to rule out it isn't anything else and let them prescribe some topical treatment and advise you if/what other options exist for your particular case. Good luck.
posted by travelwithcats at 8:18 AM on July 8, 2014 [1 favorite]

Am in the somewhat normal-to-stressed range of things (I tend towards insomnia and anxiety)

If this ramped up in the months before the melasma developed, I'd guess that overactivity of your HPA axis could be at the root of the problem.

Because a major polypeptide (POMC) produced by the pituitary segment of the axis is ultimately broken down into two separate peptide hormones, each of which stimulates melanocytes:
melanocyte-stimulating hormone (MSH) and adrenocorticotropic hormone (ACTH) share the same precursor molecule, pro-opiomelanocortin (POMC). After production in the anterior pituitary gland, POMC gets cleaved into gamma-MSH, ACTH and beta-lipotropin. The subunit ACTH undergoes further cleavage to produce alpha-MSH, the most important MSH for skin pigmentation.
ACTH is the hormone which stimulates the adrenal glands, and adrenal activity could be producing your insomnia and anxiety.

So you could try reducing your anxiety by exercise, CBT, meditation, and etc., or you could try an anxiolytic which is known to reduce the activity of the HPA axis, such as Xanax.
posted by jamjam at 9:49 AM on July 8, 2014 [3 favorites]

I freckle. I used to use the Clinique Whitener, that I got in Japan. It was expensive and since my pigment was just didn't work for me.

Dermablend (available at Ulta) is what people use for port-wine stains and other discolorations.

I do use a high SPF to keep my face from freckling, and the rest is smoke and mirrors with makeup.

I too have the discoloration on my upper lip. So I'm here to tell you, make up is the way to deal with it.
posted by Ruthless Bunny at 10:01 AM on July 8, 2014

Go to your dermatologist or GP and get a prescription for a cream that contains hydroquinone. Prescription strength is 4% and higher and over the counter is 2% maximum. It's considered safe for shorter term use and will fade the melasma effectively and the Rx version should work in 2-3 weeks. The over the counter version can take 6-8+ weeks. Then, use sunscreen religiously as even one unprotected exposure can undo the fading. Lots of mineral make-ups are also an effective physical sunblock, so you may want to use those in addition. Melasma doesn't need much encouragement to come back if you're exposed to UV light.
posted by quince at 10:20 AM on July 8, 2014 [4 favorites]

Popped in to recommend a vitamin C serum aka hydroquinone. That is the specific ingredient you want (vs the generic "vitamin C" listed) as it is what has been shown to lighten skin.

I'm a fan of Paula's Choice brand stuff so you could also try that while you're waiting for the Rx.
posted by St. Peepsburg at 11:32 AM on July 8, 2014

I also have melasma and so far haven't found anything that is working to reduce it. I haven't tried hydroquinone because of the supposed risks, yet, but i may give in. I think a lot of my problem is that i'm inconsistent. I am also fighting acne and I tend to switch products or forget to use them.

Just wanted to clarify that hydroquinone is NOT the same thing as Vitamin C as St. Peepsburg suggests above. Vitamin C is "ascorbic acid" and there are different formulas, as it tends to be very unstable and oxidize when included in products - so you may see different descriptors for it depending on how it has been stabilized.

Hydroquinone is supposed to be the gold standard for fading uneven pigmentation but it is banned in many countries. Other things that are often recommended include the above-mentioned vitamin C and azelaic acid, and also kojic acid, commonly used in Asia.

I recommend the forums at "Essential Day Spa"- particularly the DIY skincare thread.
posted by LetticeLeaf at 12:40 PM on July 8, 2014 [2 favorites]

oh, actually much simpler/better than EDS is The Beauty Brains - a blog all about the science of beauty, skin and hair care, written by cosmetic scientists.
posted by LetticeLeaf at 12:51 PM on July 8, 2014

Response by poster: Thank you, everyone. I am going to look into all of these options a bit more. (And thanks for the warning about laser treatment, Dragonness--that sounds awful!)
posted by whistle pig at 3:28 PM on July 8, 2014

I have had melasma (upper lip and forehead) for about 3 years and have read a lot of dermatology articles (peer reviewed literature) and have been doing a lot of things to try to control/reduce it. My forehead has been stubborn but my upper lip area is greatly reduced. Here is what I have done-not all may apply to you, like birth control, but I'll mention everything I've done, all based on reading dermatology journal articles. The keys are inhibiting tyrosinase activity, which can be done in different ways and limiting sun exposure as much as possible. I felt very self conscious and bothered by my upper lip and so have gone to great lengths to reduce its appearance, YMMV.

Switched from estrogen based to a progesterone implant bc

Got hydroquinone from my derm- I have not been incredibly consistent though because it causes some irritation for me, but combined with retin a, this works really well for a lot of people.

Sunscreen (50+) at all times except when I wash my face at night to go to bed. Avoiding the sun is very very very vital here. If you get rid of it but don't stay out of the sun (even one afternoon in sun with no sunscreen), all your work will be ruined.

Only use sunscreen that does not contain chemicals that mimic estrogen receptors (which seems to cause tyrosinase activity to go wild)-those are in many types of sunscreen, if not most in the US that have chemical blockers (such as oxybenzone). I use a European garnier sunscreen with mexoplex, which doesn't seem to have any estrogen activity or include ingredients that are known to have this issue. It's ironic that the chemicals you use to stop the sun could contribute to melasma...ugh! Physical blockers, I.e., titanium dioxide and zinc both do not mimic estrogen (but are often combined with chemicals that do!).

Take grape seed extract pills (shown to be effective for melasma in peer reviewed literature), as well as a topical that contains it, plus arbutin and niacinaminde in the topical, also known to inhibit tyrosinase. I also use a mask of silymarin extract a few times a week, again based on some peer reviewed lit.

Take astaxanthin supplements-this is a carotenoid that seems to have a lot of potential to help with uv damage-some studies have shown its effectiveness but it's not super well known as of yet. Several decent peer reviewed papers about it though. Also, it seems to naturally increase your own SPF by a tad, and if this is about anti-sun, that can't hurt!

12% TCA peels (I've done them at home, you may or may not be comfortable with this, but it can be done safely and cheaply, but for sure you would want to research this yourself. Your derm can do them or stronger ones as well, this is one thing that has made a huge difference for sure). I've done 3 so far.

Wear a very large brimmed hat whenever I'm outside.

Try going to google scholar and searching for melasma treatment (or use any of the terms I've mentioned with it, if, say you want to read about the grape seed extract and what the studies have shown, etc. I'm on my iPad and linking is a little tough at the moment). Googling for estrogenic sunscreens is also worth checking out. I am not some woohoo supplement taking sort of person, but the things I mentioned here are backed up with science and don't seem to have any negatives, so you may want to look into them. I will say, my upper lip melasma is basically gone and my skin otherwise, with all this attention, has never in my life looked better (in my early 30s). Good luck, because I've been in tears over this in the past, but I have finally made some progress, so I wouldn't give up!
posted by PinkPoodle at 3:52 PM on July 8, 2014 [3 favorites]

Also agree with dragoness about the lasers, lots of horror stories about it making it much worse in the long run, so thoroughly research anything on the more risky/medical end for treating this!
posted by PinkPoodle at 3:55 PM on July 8, 2014

Mix one teaspoon of vitamin c in 2 teaspoons distilled water and apply twice daily. Work up to twice daily, it's kind of stingy at first. The mixture has to be stored out of the Sun and it only lasts a few days but it costs pennies and it worked for me. I had more or less permanent sunglass/ goggle lines under my eyes before I tried this.
posted by fshgrl at 4:43 PM on July 8, 2014

Response by poster: Thanks for the further suggestions! PinkPoodle, I will give those a go.

Also, just noticed for some reason that "melasma" kept autocorrecting to "melisma" in my question above. Pride forces me to point out that I really do know how to spell.
posted by whistle pig at 5:07 PM on July 8, 2014 [1 favorite]

Are you generally feeling well otherwise? If so, please disregard.

If you are struggling with things like overwhelming fatigue, low blood pressure, fever, unexplained weight loss, etc, then while it is very rare, melasma can be a sign of Addison's disease. My sister was experiencing the above symptoms as well as melasma on her upper lip and was diagnosed with Addison's recently. Treatment has made a big difference!
posted by wiskunde at 8:23 PM on July 18, 2014

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