A recent email exchange with a reader got me thinking about melasma, a condition that is distressing and frustratingly challenging. Melasma, an affliction that results in dark skin discoloration, requires a long-term management plan and a multi-pronged approach.

Surprisingly, since it is relatively common, melasma is not well understood. Melasma (from the Greek word melas meaning black) is often associated with the female hormones estrogen and progesterone. It is especially common in pregnant women, when is known as chloasma.

This may be because there are estrogen receptors on the melanocytes that stimulate cells to produce more melanin. And, certainly, women are more often afflicted by men. However, darker complexions and exposure to intense sunlight are also factors (melasma is the most common pigmenary disorder amongst Indians).

Whatever the mechanisms, melasma results in an increased deposition of melanin in the epidermis, in the dermis within melanophages, or both. Melasma usually begins with brownish macules and progresses to patches with well-defined borders (source).

So what to do if you have melasma? Well I am not going to advocate the traditional remedies of tretinoin (which is cytotoxic), kojic acid (a strong irritant and dose restricted in Europe), hydroquinone (carcinogenic) or azelaic acid (effective concentrations need to be high and risk irritation and unwanted hair growth).

Before going into to some safer options, I should mention that wearing a daily sunscreen is essential. It is also advisable to avoid skincare products that irritate the skin as this may worsen melasma (take care to avoid products with chemical fragrance, for example).

The thing about melasma and other form of hyperpigmentation is that it is very difficult to eradicate. In a month and half, I wouldn’t expect much if anything. It may take three or four months to see any effects and more than a year for dramatic improvement. So, I am afraid that you will have to be very patient and have a disciplined regimen.

The regimen should comprise a gentle but effective exfoliator, a melanin/tyrosinase inhibitor, an antioxidant combination that includes ferulic acid, LED light and sunscreen.

The exfoliation part can use a good AHA peel (Lumixyl’s Glycopeel, or Juice Beauty’s Green Apple) or a good retin A formula. In fact, readers have specifically commented that Prana’s Reverse A ($48 in the shop) has ridded them of melasma.

Because melasma is a complex, multi-stage process in which precursor molecules are acted upon by the enzyme tyrosinase, a tyrosinase-inhibitor is a good thing to look out for. Lumixyl’s Topical Brightening Creme ($120) has a fancy one that was developed at Stamford University. MAD Spot On ($38/0.50 oz in the TIA shop) has a whole slew of lightening agents.

Antioxidants and ferulic acid combos are strangely hard to come by, which is a pity since the research showing that vitamins and ferulic acid protect from the sun is pretty good. Dr. Dennis Gross has a ferulic acid and retinol serum. And there are C + E Ferulic serums by Skinceuticals and CSS. Mad Hippie’s Vitamin C Serum ($30 in the shop) also comes with vitamin E and ferulic.

Vitamin C is often touted as a powerful skin brightener and is the major component of some skin brightening lines, such as the new one from Bobbi Brown. Indeed, research has shown that it can have a significant effect in the treatment of melasma – but at a whopping 25% concentration. Stable versions, such as MAP can have a protective effect against UVB radiation and inhibit melanogenesis having a lightening effect over half of patients with melasma treated (source). MAP is in MAD’s Spot On (although it is likely a much lower concentration than in these studies).

Green LED light, used regularly, may also help as it is known to help fade dark spots and hyperpigmentation.

There are no silver bullets, but this multi-pronged plan and the willingness to accept that real change may take as much as year may help to confine melasma to a distant memory.