The Nurx medical team has been looking at lots of photos of faces — the faces of our patients requesting treatment for acne, sun-related aging, and rosacea. But they noticed that many of these photos also revealed signs of melasma, a skin condition characterized by patchy dark spots and discoloration, often caused or exacerbated by sun exposure and hormonal fluctuations. It’s not surprising that so many Nurx patients experience melasma, because it’s most common in women 20-40, which pretty precisely describes the Nurx community.
So to offer you specialized solutions to this common skin condition, we have launched melasma treatment, which includes a comprehensive online evaluation, personalized prescription plans, medication delivery and ongoing follow-up care.
To help you learn more about melasma and understand if treatment is right for you, we turned to Dr. Marie Leger, a dermatologist and one of the Nurx clinical advisors who created our melasma treatment plan. Read on for her expert answers on this common skin condition.
Birth control from Nurx costs as little as $0 with insurance or $15 per month without insurance.
What causes melasma, and why are some people prone to it?
Melasma is most common in women of reproductive age who have medium to medium-dark skin, and there is a hereditary component — about half of people with melasma report having a relative who also experienced the condition.
It may first appear as a result of sun exposure or hormonal fluctuations, like those experienced in pregnancy or if you’re taking birth control containing estrogen.
How do you treat melasma?
The gold standard, best studied treatment is topical hydroquinone cream. Hydroquinone is a tyrosinase inhibitor, which blocks an enzyme to decrease melanin production in the skin. After 2-3 months of consistent use you should see a significant improvement in melasma.
In rare cases prolonged use of hydroquinone can cause something called ochronosis, which paradoxically darkens the skin and can be permanent. This has mostly been reported with use longer than six months so to be cautious we only prescribe a three-month supply of hydroquinone at Nurx. After three months we’ll switch you to a maintenance treatment, usually azelaic acid or tretinoin. Both of these can also improve melasma. After you’ve taken a six month break from hydroquinone we may prescribe you another three-month supply.
Are any other treatments effective?
There are many over-the-counter products that can be helpful with melasma too. Look for ingredients like kojic acid, vitamin C, and licorice extract. But, there are also many over-the-counter “skin lightening” treatments that are ineffective or even dangerous–such as those containing strong steroids that are not legally available in the United States. Avoid those products, and don’t try harsh treatments like alcohol or scrubs. Many of these products can make hyperpigmentation worse!
Everybody wants a magic laser to make melasma go away, but in some cases laser treatments can make it worse so you have to be careful. If you reach a point where you are not seeing much improvement with topical treatment or where you would like to explore the kinds of options that are only available in person, we will refer you out.
What lifestyle changes can help?
I can’t emphasize tinted sunscreen enough! UV light and visible light both can worsen melasma. Sunscreen (both physical and chemical blockers) protects against UV light, and tinted sunscreen in particular protects against both UV and visible light. The best sunscreen is the one you will use. Find one you like and use it every day, and aim to reapply every two hours if you are in the sun. Hats are also extremely helpful. If you are getting tan you are getting too much sun. Melasma is persistent— you can make it much better with diligence and care, but if you forget sunscreen it will flare and undo your progress.
Melasma is quite common during pregnancy and hydroquinone isn’t safe during pregnancy or breastfeeding. However, there are safe ways to prevent and treat melasma during pregnancy, such as sun protection and azelaic acid, and pregnancy-related melasma often improves a few months after delivery.
If you suspect that birth control is worsening your melasma, tell your medical provider to discuss whether a formula with less or no estrogen might be a better choice for you.
Is there a cure for melasma?
Melasma is a chronic condition, but we can significantly improve it with the right treatments and by avoiding sun exposure. But don’t be discouraged — with diligence and persistence we often see it get so much better! The Nurx medical team is here to help—and once again…SUNSCREEN!
Interested in getting melasma medication prescribed online and delivered to your door? Request melasma treatment now!
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.