Facial pigmentation such as melasma and postinflammatory hyperpigmentation can be so discouraging and all too common. These conditions are notoriously stubborn and require consistency and diligence in your routine. Because I get this question almost daily in my DMs, I wanted to create a post on the basics to help you combat mild pigmentation disorders. To clarify, these are over-the-counter products and steps you can take to help improve melasma and post-inflammatory hyperpigmentation. I always recommend consulting with a Dermatology provider to confirm the condition you're dealing with and rule out other possible conditions and causes.
Firstly, let's cover some basics.
Melasma is a chronic disorder with no "cure". It is often seen in women of childbearing age, in pregnancy and in those on hormonal birth control. Common areas are the upper lip, nose, cheeks and forehead. It is most commonly, not always, seen in areas of frequent sun exposure. As you may have gathered hormones (estrogen) and sun exposure are believed to be the most common triggers. Sun exposure will always exacerbate this condition. If you suffer from melasma you've undoubtedly noticed this correlation when it flares in the summer months! It is also suspected that heat itself (in the absence of direct sun exposure) can flare melasma. If I so much as sit in a hot car, my upper lip will look like I grew a mustache. #sunstache.
Post-inflammatory Hyperpigmentation is another common condition amongst my patients and in my DMs. The question is often framed as "what can I do for acne scarring?". You should know that the flat red/brown marks left over after a pimple are not true scarring but rather postinflammatory erythema vs. pigmentation. This is a good thing! We can treat this topically. Also note that PIH can occur after any inflammatory process such as bug bites, irritation from a skin care product or peel, eczema, scratches, burns, etc. This condition is also more common in those with darker skin types and asian and mediterranean decent.
So now we have the basics out of the way... how can we treat mild pigmentation with an efficacious skin are regimen? Here are a few staple steps.
SUNSCREEN SUNSCREEN SUNSCREEN. Although this obviously isn't the first step in your regimen, I write it first because it is BY FAR the most important. I cannot say it enough. You can spend all the money and time in the world finding the best lightening products and be absolutely diligent about their use, but if you're not using a broad-spectrum SPF of at least 30 (your makeup doesn't count!) EVERY. SINGLE. DAY. your pigmentation will not improve. Furthermore, the HEV-light or blue light from our computers, phones and TVs has been implicated in worsening pigmentation. To combat this you'll want to opt for a tinted SPF because the iron oxides offer HEV protection. Here are some of my favorites!
Elta MD UV Elements – great for very dry skin!
PCA Sheer Tint: Most sheer coverage
Revision Intellishade Truphysical – make-up like coverage
ALPHA HYDROXY ACIDS - These chemical exfoliants will help to prevent your skin cells from sticking together thus allowing the outer dead layer to slough off more easily. Combined with the right de-pigmenting agents, this increase in exfoliation will allow the pigmented cells to slough off while new, healthy cells take their place. It's important to note that inflammation is the enemy with pigmentation so incorporating these ingredients and products slowly to minimize irritation is key! Below are some of my favorite AHA/BHA products!
Lightening agents. Lightening ingredients work in various different ways (depending on their mechanism of action) to inhibit pigmentation in your skin cells. Some of my favorite lightening ingredients are Vitamin C, kojic acid, Niacinamide, azaleic acid, arbutin, and tranexamic acid. Below are some of the lightening serums I recommend daily for both melasma and PIH.
SkinMedica Lytera 2.0:
Antioxidants. Whether topical or otherwise, antioxidants provide your skin an added defense from free radicals. These are crucial in any anti-aging and pigmentation regimen! Below are a couple of my favorite topical antioxidants and one oral supplement I love for the treatment and prevention of pigmentation.
SkinCeuticals Phloretin CF for oily, non-sensitive skin
Revision Skincare C+ Correcting for Dry and sensitive or acne prone skin
SkinCeuticals CE Ferulic- for dry, non-sensitive skin
Retinoids. These powerhouse ingredients are pretty crucial when it comes to a comprehensive anti-aging regimen. They are also key players in a comprehensive regimen for melasma and PIH (as long as you're not breastfeeding or pregnant). Below are a few of my favorite over the counter retinoids. Again irritation is often the enemy of pigmentation so starting these products slowly is key. I recommend checking out this video on how to start retinoids while minimizing irritation.
While knowing your specific skin type is key when creating a regimen, these are the staples you'll need to fend of pigmentation. A Sample regimen for melasma of PIH would look something like this:
- Eye Cream
- Antioxidant Serum
- Eye Cream
- Lightening Agent
Amy is a Cosmetic Dermatology PA and skin care enthusiast living and practicing in Miami, FL. To connect with her or to see her in office or virtually for a consultation, contact her via her instagram @the_skinthusiast or on her blog www.theskinthusiastblog.com