Treating Melasma

Recently I was approached by a dear friend who suddenly had the appearance of a brown 'splotchiness' on her upper lip of which she was finding very distressing. When she is not wearing any makeup it appeared (her words not mine) as if she had a mustache and as you can imagine she found this very stressful and embarrassing. I suggested she visit with her doctor and he diagnosed her with Melasma. 
Together, over the next few months we are going to keep a record of the treatment she will undertake along with the results and outcome which hopefully will be of some help and encouragement to those who are experiencing the same condition.
What Causes Melasma
Melasma is caused by over active melanin producing cells called melanocytes. This is caused either externally (excess sun) hormonally (oral birth control, hrt treatment and some oral medications) or genetic predisposition.
It really is important that you find out what is the root of the problem because if you don’t you will just end up wasting your time, money and even worsening the situation as melasma is notorious for returning the second time darker than the original outbreak. 
External Causes
If the cause of your melasma is through external causes treatment is somewhat easier. However the process is still rather slow and it takes comitment and patience along with religous use of sunscreen and protective clothing such as a large protective hat and staying out of the sun as much as possible.
Hormonal Causes
If you are currently on oral birth control or on hrt treatment this could be the root of your problem and you should check with your doctor to see if your melasma is hormonal based and you can do this by having your Estrogen levels checked to see if you are Estrogen dominant. Also Melasma can rear its ugly head after a pregnancy, however once the underlying hormonal cause is taken care of you can then work on it topically.
For optimum health, the progesterone to estrogen ratio should be between 200–300 to 1
 









The above chart shows that from the age of 35 to 50, there is a 75% reduction in production of progesterone in the body. Estrogen, during the same period, only declines about 35%. By menopause, the total amount of progesterone made is extremely low, while estrogen is still present in the body at about half its pre-menopausal level.
With the gradual drop in estrogen but severe drop in progesterone, there is insufficient progesterone to counteract the amount of estrogen in our body. This state is called estrogen dominance. Many women in their mid-thirties, most women during peri-menopause (mid-forties), and essentially all women during menopause (age 50 and beyond) are overloaded with estrogen and at the same time suffering from progesterone deficiency because of the severe drop in physiological production during this period. The end result - excessive estrogen relative to progesterone, a condition we call estrogen dominance.
Diet and Melasma
Women who drank four to five cups of coffee daily had nearly 70% more estrogen than women who consume less than one cup of coffee. Tea is not much better. And for that matter, neither are soft drinks with caffeine in them like Red Bull or Mountain Dew.
Having a high body fat content also intend to have an Estrogen dominance therefore losing some weight along with exercise will lower Estrogen levels.
Vitamin B6 and magnesium are needed to neutralize estrogen in the liver. Therefore make sure you do not have a Vitamin B6 deficiency.                                                                          Who Can Get Melasma 
Melasma is most common in women 20-50 years of age
Melasma Appearance
Melasma looks like brown, tan, or blue-gray spots on the face (hyperpigmentation).
Most Common Areas for Melasma
Melasma is characterized by three location patterns (central face, cheekbone, and jawline)
Treatments
Melasma may clear spontaneously without treatment. Other times, it may clear with sunscreen usage and sun avoidance. For some people, the discoloration with Melasma may disappear following pregnancy or if birth control pills and hormone therapy are discontinued. But most commonly it requires topical treatment along with long term sun avoidance,
Finacea (Azelaic Acid) 15%-20% Azelaic acid is a non-hydroquinone cream that can be used to treat melasma. Studies have reported that 15%-20% azelaic acid was very effective and safe in melasma. There are no major complications reported with azelaic acid. Possible minor side effects include itching, redness, flaking and a temporary burning sensation that tends to improve after 14-30 days of use.
Retin-A 0.025%-0.1%
OR
Tazorac 0.05%-.01%
Both of the above help increase the effects of the Azelaic Acid (Finacea) enabling it to penetrate deeper
Topical Vitamin C 10%-20% (click HERE)
Obagi Nu-Derm system (click HERE)
Lactic Acid Lotions 12% (click HERE)
Regular skin lighteners that have arbutin, mulberry extract, bearberry and licorice can help especially in combination will the above.