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The Difference Between Melasma and Hyperpigmentation – and How to Treat Them Both

Hyperpigmentation is a broad term that refers to a skin condition in which the skin is discolored, darkened or unevenly toned. It is one which can be brought on by many different factors but is often a by-product of acne scarring, sun damage, or inflammation lingering from an eczema flare-up.

But, as it turns out, there’s a type of hyperpigmentation that you may have never heard of known as melasma. Melasma is a pigmentary condition that affects more than five million Americans, most of these being women. Much like general hyperpigmentation, melasma appears in the form of discoloration on the skin and is exacerbated by exposure to the sun. However, there are actually quite a few differences that set it apart from typical hyperpigmentation.

It’s important to know the differences between these two conditions if you choose to treat them. Ahead, a definitive breakdown of melasma and hyperpigmentation, the differences between the two, and how to treat them.

Hyperpigmentation

Whether you have post-blemish scarring from a stubborn acne breakout, freckles that expanded into full-blown sun spots from excess exposure, or discoloration caused by a condition like eczema or psoriasis, the discoloration usually all falls under the umbrella of hyperpigmentation. This is because acne, sunlight, skin rashes, and the like have the potential to stimulate melanocytes, the pigment-making cells in the skin, to produce an excess of pigment, which is ultimately released into lower levels of the skin (similar to tattoo pigment), where it doesn’t belong. The deeper the pigment, the more difficult it is to treat. For example, a section of skin that’s been consistently exposed to harmful UV rays without the proper protection will be harder to diminish than say, a dark spot leftover from a pimple that you’ve been careful to shield from the sun. In other words, the level of severity varies, but if you spot discoloration on your skin that wasn’t there before, it’s safe to assume it’s hyperpigmentation. But always consult your Columbus esthetician and/or a dermatologist to be certain.

Melasma

Melasma is a form of hyperpigmentation, and again one that is more commonly seen in women, especially those with darker skin tones. It is thought to be triggered by UV exposure, as well as hormonal influences. The latter is what distinguishes melasma from traditional hyperpigmentation, and that which makes it more difficult to treat. Hormonal influences play a significant role in the condition, as seen by the increased prevalence during pregnancy (can occur in up to 50 percent of pregnant women which has lead to it being referred to as the mask of pregnancy), oral contraceptive use, and other hormonal therapies. Estrogen and progesterone rise steeply during pregnancy which stimulates excess melanin production and makes skin more sensitive to sunlight. As a result of this, skin, freckles and moles may look darker, and you may notice a dark line down the center of your abdomen (the lineament nigra). The problem is preventing its worsening, especially from the hormonal angle, as it can be hard to remove the instigating factors. The good news is in the case of pregnancy, the discoloration is usually temporary and typically disappears after delivery or, in some cases, after you finish breastfeeding.

You can usually tell if you have melasma based on its appearance alone. It typically appears as symmetric blotchy hyperpigmented patches on the face, usually the cheeks, bridge of the nose, forehead, chin, and upper lip. While less common, melasma can present on other parts of the body — especially those more prone to sun exposure (like the neck and forearms) — and many people say their melasma worsens in the summer and improves in the winter. It may also appear during pregnancy or after starting birth control or other hormonal treatments and drugs such as phenytoin (pigmentation tends to disappear in a few months after discontinuing use of the drug). Something to consider if you’ve noticed discoloration appear shortly after switching up your birth control or undergoing a hormonal change.

Finally, recent research has found that blue light emitted from CFL and LED light bulbs, computer screens, cell phones, television and other electronics can worsen melasma. We recommend using sunscreen and/or makeup that contains iron oxide to help block blue light.

Most treatments are the same, but melasma is harder to get rid of.

As previously mentioned, melasma is difficult to treat. This is because, unlike traditional hyperpigmentation, which responds to a variety of skin care products that contain brightening agents like vitamin C, kojic acid, niacinamide, hydroquinone, and azelaic acid, melasma hasn’t seen the same rate of success or consistency.

Often what works for one person doesn’t work for another, therefore, it’s difficult to pinpoint one treatment that is most effective for melasma. We recommend a combination of sunscreen, brightening ingredients, and laser treatments, whereas, for basic hyperpigmentation, we typically recommend chemical peels in place of lasers. That said, peels, bleaches and other chemically based lightning treatments should be avoided during pregnancy and while breastfeeding.

Lasers in lower energy range can be helpful in treating hyperpigmentation including Light Therapy (Red Light and Near-infrared), while melasma is best treated with low energy Fractional and IPL Lasers, and higher energy lasers such as the PiQo4 Laser. Low-energy fractional lasers use low-energy fractionated technology to improve melasma, sun damage, and skin texture. The only caveat? Multiple treatments (at least three) will be needed on a monthly basis, and then every six months thereafter to help maintain results. High-energy lasers use high-energy which translates to faster results, in the case of the PiQo4 40 percent less treatment time in fact. The PiQo4 is the only laser in the U.S. that offers four wavelengths and the ability to deliver both nanosecond and picosecond pulses allowing the laser to not only more effectively treat melasma but also making it suitable for all skin types and tones including darker skin tones. Basically if you have pigment issues, the PiQo4 is the laser to try. Plus, as the treatment works to combat pigment concerns, it’s also helping to boost natural collagen production in the skin, which can make it look more youthful.

When considering melasma treatment overall, however, topical treatment is the key to success. It should be used before any light or laser procedure and, to decrease the risk of relapse, it should be continued even when those procedures are recommended. Topical hydroquinone is the most common lightening agent used. It works by decreasing the production of pigment. Your doctor may recommend combining it with tretinoin (or other medical-grade Retinol Vitamin A), corticosteroids, antioxidants or other topical products for added efficacy. In some cases, superficial chemical peels also may be considered to remove pigment.

Treatment depends on the severity of your melasma. Everyone’s experience will be unique, and no single treatment plan will work for everyone. So whether you have stubborn hyperpigmentation or melasma, be sure to talk with your esthetician, and/or dermatologist to determine the best pigment balancing treatment protocol for your skin.

You cannot correct or prevent hyperpigmentation or melasma without sun protection.

We’ve stressed the importance of diligent sunscreen use too many times to count, but that’s because it’s basically the end-all-be-all when it comes to staving off any sun-induced ailment. While melasma is also triggered by hormonal factors, this does not mean you should slack off on the SPF, as UV rays are still responsible for magnifying the condition. We recommend applying an SPF 25 or higher every two hours, even if you’re just going to be inside sitting near a window. It also can’t hurt to double up on the protection with a moisturizer or makeup that contains SPF.

Bottom line: Hyperpigmentation and melasma happen, but with the proper precaution (sunscreen) these skin conditions can likely be avoided.

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