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When Hormones Attack: Melasma

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Hormones affect women at the most pivotal times in life: during the tumultuous teenage years, during and after pregnancy and breastfeeding, and during menopause.

It’s not enough that the hormones completely disrupt our emotions and internal systems of the body. Hormones sometimes also choose to announce their presence to the world by showing up as spots or patches of hyperpigmentation (dark pigment) on the skin. There are several types of hyperpigmentation that have different causes, but this type is called melasma. Since melasma often accompanies pregnancy or pregnancy-related hormones, it is often referred to as the “mask of pregnancy” or “pregnancy mask”.

Melasma almost always appears on the face with a specific and symmetrical mask-like pattern. This “mask” often covers the forehead, cheeks, chin, jawline, and upper lip. The severity amount of pigment varies based on how much melanin pigment the person naturally has in their skin. Those with lighter complexions are affected less, while those with more pigmented complexions (people of Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent) are more prone to develop this condition.


 

Not just a mask of pregnancy

Although melasma is best known for affecting women during and after pregnancy, it is not exclusive to it. Women who take birth control hormones at any point during their lives, as well as women who are anywhere around the age of menopause are also often affected.

Melasma is a self-limiting condition, meaning it will eventually fade on its own once the hormones have subsided, but will often return once the hormones become unbalanced again due to another life event or medication. Not all, but some women will exhibit some degree of melasma for years; for example if they go from taking birth control hormones, to becoming pregnant, to breastfeeding, back to birth control hormones, maybe having subsequent pregnancies, right into perimenopause or menopause.

Melasma is primarily a condition that affects females because of the abundance of the hormones estrogen and progesterone, however 10 percent of men get some form of it as well.

Are hormones the only cause?

Experts are still unclear of all of the causes of melasma, though hormones are widely believed to be its primary cause. It is suspected that inflammation and free radicals also cause it, like other forms of hyperpigmentation, since they have the ability to alter DNA and interrupt normal cell processes.

The cells that produce melanin pigment in the body are called melanocytes, and they are located in the deepest layer of the epidermis (outermost layer of skin), commonly referred to as the basal layer. The primary purpose of melanin pigment in the body is protection from UV radiation. UV radiation creates free radicals in the skin, thus the melanocytes jump into action, producing more melanin pigment to fight them off. It is a fact that excessive sun exposure causes hyperpigmentation in general, and that it can exacerbate melasma; but most experts do not believe the sun alone is responsible for melasma.

Melanocytes are tricky cells. They are easily triggered as part of the body’s inflammatory response process if they feel the skin or body is unbalanced. Drastic changes in the levels of estrogen and progesterone can trigger these cells and cause them to produce more melanin pigment.

The American Academy of Dermatology also suggests that the use of irritant cosmetic products or treatments may also cause melasma.

But I can’t control my hormone levels…can I?

Many people believe that their hormonal activity is out of their control. And this is mostly true. However, from a holistic perspective, there may be some dietary issues that either mimic or trigger hormonal activity. Many foods that are high in sugar, gluten, and yeast can have an estrogenic effect on the body. These foods also feed and breed Candida, causing an overgrowth of this fungus which leads to more inflammation, free radical production, and degradation of the immune system. Certain medications and chemical ingredients can also produce an estrogenic effect in the body.

Stress can also make hormonal imbalances worse.

While it is not possible to fully control hormone levels in the body, there are some dietary and lifestyle changes, as well as relaxation and stress reduction techniques you can try to even them out a bit.

How NOT to treat melasma.

In allopathic medicine, melasma is usually treated by the use of tretinoin (Retin-A) or another aggressive resurfacing Vitamin A derivative, in addition to the tyrosinase inhibitor (lightening agent) hydroquinone, or a corticosteroid. Sometimes a topical cream containing all three ingredients, known as a “triple cream” is used.

In the medical spa environment, melasma is often combated with the use of chemical peels, microdermabrasion, and laser resurfacing or IPL treatments.

To all of this I say NO.

Retin-A and other retinols, are not a good choices because, while they may offer a temporary fix, they cause more damage long-term because they inflame and generate free radicals in the skin, and irreparably thin the dermis and damage the collagen and elastin-producing cells within it. It also causes the skin to be hypersensitive to the sun’s UV rays, as well as other elements, which actually makes the skin more susceptible to hyperpigmentation. Corticosteroids are also a quick fix, but are generally not recommended for long-term use due to safety issues. They can also contribute to Candida overgrowth.

Hydroquinone is a fairly controversial ingredient. It is the most popular and commonly used lightening agent on the market because it works. It is available OTC in lower percentages, or double that strength as a prescription. It works by suppressing melanin production. If you recall, melanin is there for a reason: to protect against UV rays. Therefore, suppressing its production will also make the skin more sensitive and vulnerable to UV damage, which in turn will cause more hyperpigmentation. Kind of an oxymoron don’t you think? “Its irritancy level can result in Exogenous Ochronosis, a permanent, deep bluish/black stain in the skin” as well.

Furthermore, there have been reports that suggest hydroquinone is toxic; specifically that it is carcinogenic and a neuro-toxin. It has already been banned in some countries that have stricter regulations on toxic and chemical ingredients than we do in the US. Doctors who prescribe hydroquinone do not recommend it for long-term use, but many people ignore this because they like the results it produces. It is on the “toxic 12” list of cosmetic ingredients as well. Further studies have been ordered by the FDA under the National Toxicology Program. For any and all of these reasons, I strongly advise against using this ingredient.

I also advise against the use of laser, microdermabrasion, and chemical peels to treat melasma. First of all, most of these (in addition to the medications listed above) are not safe for use during pregnancy. Since many cases of melasma present during pregnancy, that is a huge red flag. Furthermore, it is the same situation where these may be great quick fixes, but cause inflammation which leads to long-term problems such as dermal thinning, degradation of collagen and elastin, and more hyperpigmentation.

There are several effective alternative treatments that are safer both short-term and long-term.

How TO treat melasma.

The first steps to take if you have melasma is to take a look at your diet and lifestyle and make the necessary changes in order to reduce the risk of Candida overgrowth and estrogenic activity in the body. It is also necessary to use proper sun protection on a regular basis, and reduce stress levels as much as possible.

Once these holistic measures have been taken, you can try a pigment fading product that contains natural lightening ingredients. The ingredient paper mulberry has been shown to be even more effective than prescription strength hydroquinone in fading melasma and hyperpigmentation, especially when used in conjunction with bearberry. Other natural ingredients that relax over-productive melanocytes (without suppressing them completely and causing photosensitivity in the skin) are watercress, mandelic acid, lactic acid, lemon peel extract, apple cider vinegar, and Vitamin C (L-ascorbic acid). Look for high quality, well formulated professional products that contain these anti-inflammatory, yet effective ingredients.

Specific skin care issues like melasma are best treated with use of a complete skin care regimen, in addition to the holistic means suggested above. If you have melasma, or any other non-threatening skin issue, it is a good idea to consult with a licensed aesthetician and/or holistic healthcare provider.

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About Rachael Pontillo

  • Inv

    This is a great article. I was particularly pleased to read your warnings about hydroquinone – because of its safety fears it is only available by prescription in Europe and it is highly regulated in Asia. Most people don’t realize that the skin-lightening effects of hydroquinone also decrease with prolonged use and with sun exposure. Kojic acid, another popular dark-spot treatment also has safety concerns.

  • http://blogcritics.org/writers/rachael-pontillo/ Rachael Pontillo

    Absolutely! There are many safer and very effective alternatives.

  • Jen

    Hi Rachael, great article. What do you suggest doing with the paper mulberry? Ingesting some form of it or rubbing it on the skin? Thanks :)