UNMASKING MELASMA: Top Questions Answered by Brian Nailling, PA-C

Pretty woman looking herself in mirror at home

Melasma impacts around 5 million individuals in the U.S., as per the National Center for Biotechnology Information. Brian Nailling, PA-C, DMSc, at Vitalogy Skincare, answered the top melasma questions, including its nature, symptoms, and available treatments.

Q: What is melasma?

Melasma is darkening of the skin resulting from overactive pigment producing cells. These cells, called melanocytes, produce pigmentation, or melanin, to protect the skin from the damaging effects of UV light. In the case of melasma, these specialized cells have become overactive and produce too much pigmentation. Since the role of these cells is to protect from damage caused by light, the more light exposure they get the more pigmentation they release and the darker the area becomes.

Q: What causes melasma and how is it diagnosed?

The factors that cause melasma are varied and complex. Genetics plays a role and there is a strong familial tendency for the condition. Hormonal factors are also involved. Skin that is affected by melasma shows higher rates of receptors for estrogen and progesterone. Disruption of the natural barrier function of the skin by UV damage is an important contributor to the severity of melasma.

The diagnosis of melasma is typically made based on its characteristic appearance. In situations where there is uncertainty about the diagnosis, an evaluation using a Wood’s lamp, or a specialized magnifying glass known as a dermatoscope, can help. If there are concerns about the presence of other conditions, a biopsy might be necessary.

Q: Who is most at risk for developing melasma?

Although it can affect anyone, women, individuals with darker skin tones, people with immediate relatives with melasma, or those that have high amounts of UV exposure are at highest risk for developing melasma. Studies have identified UV exposure and pregnancy as the most frequent triggers for melasma.

Q: Where on the body can you get melasma?

Skin that receives significant sun exposure is most susceptible to melasma, with the face being the primary area of impact. In rare cases, the condition may manifest in areas beyond the face, such as the back, chest, and forearms.

Q: Are there proactive steps individuals can take to assist in managing their melasma?

The most important step in managing melasma is prevention. I recommend the daily use of a mineral-based sunscreen with an SPF of 50 or higher, preferably one that includes iron. While many individuals understand that UV light exposure can exacerbate melasma, it is crucial to recognize that visible light can also contribute to the condition’s worsening. Iron plays a key role in shielding against visible light, yet not all sunscreens incorporate iron. Even when medical treatments yield optimal outcomes, ensuring effective protection against both UV and visible light remains paramount, as melasma is highly prone to recurrence without preventive measures.

To put it succinctly, individuals with melasma, or those aiming to prevent it, should diligently apply suitable sunscreen every day, even on days spent mostly indoors, as artificial lighting in our surroundings can also influence melasma. Remember to reapply sunscreen every few hours throughout the day to maintain its effectiveness.

Q: Are there any effective treatments for melasma?

Yes, several treatment options for melasma exist. Depending on the severity of the condition a combination of lightening creams, chemical peels, oral medications, and even certain laser procedures are options. Once your medical history has been reviewed and your skin has been examined, your dermatology provider will recommend the most suitable treatment approach for your specific situation. Each treatment option for melasma carries its own risks so it is important to discuss these with your provider. Melasma is a notoriously difficult condition to manage and even after a desired result is achieved prevention of recurrence is critical.

Q: Can certain medications and cosmetics trigger melasma?

Some hormonal contraceptive medications and other hormonal therapies have been associated with melasma. When discussing options for these medications with your provider it is important to ask about the risk of melasma if this is a concern for you. Although some data has been published that indicates people attribute their melasma to cosmetic use, no causative association has been found.

Q:  Is melasma reversible?

Fortunately, we have many options for management when it comes to melasma. Tailoring the appropriate treatment to the specific patient can yield remarkable outcomes. Nevertheless, it is important to acknowledge that melasma boasts a notably high rate of recurrence. This underscores the significance of prevention, achieved through consistent application of a mineral-based sunscreen with an SPF of 50 or higher that includes iron. This preventive measure is pivotal in impeding progression and minimizing the likelihood of melasma recurring.

Ensure that the healthcare provider you consult possesses expertise in treating skin conditions, such as a dermatologist or a physician assistant with dermatology training.

For additional questions about melasma and treatment options or to request an appointment with Certified Physician Assistant Brian, visit VitalogySkincare.com or call 512.930.3909.

About the Provider:
Brian Nailling, DMSc, PA-C, is a Certified Physician
 Assistant with extensive experience. After graduating from the Interservice Physician Assistant Program in 2009, he embarked on a successful military career spanning almost a decade. His passion for medical dermatology and proficiency in skin cancer treatment blossomed during this time. Brian holds certifications from the National Commission on the Certification of Physician Assistants and is licensed by the Texas Medical Board. He is a distinguished Diplomate Fellow of the Society of Dermatology Physician Assistants, showcasing his dedication to the field. Outside work, he cherishes family time, cooking, fishing, guitar playing, and travel. His core belief is that each patient deserves top-tier care, and he aims to positively impact their dermatological health and overall well-being.

Since 2007, Vitalogy Skincare has been Central Texas’ choice for dermatological care with best-in-class Board-Certified Dermatologists, Fellowship-Trained Mohs Surgeons, and Licensed Aestheticians. Visit VitalogySkincare.com to learn more about our medical, cosmetic, and surgical services. Schedule appointments online or call 512.930.3909.

Originally published “Unmasking Melasma: Top Questions Answered by Brian Nailling, PA-C” 
(Aug 28, 2023) Edible Austin