What is Melasma?
Melasma is most common on the cheeks, upper lips, chin, and forehead, but other sun-exposed areas may also occasionally be involved. “Melasma is a common hypermelanotic ( increase in pigment) disorder affecting the face, and it is highly associated with considerable psychological impacts” (Handel, 2014). Melasma is characterized by large flat patches of discoloration, and it can be caused or driven by UV light and hormones.
The management of melasma is challenging and requires a long-term treatment plan. Therefore, although melasma can be very distressing to have, it’s important to make peace and know that some of the pigment is very deep and can take years to treat. And sometimes, the treatment won’t always have the results that the patient desires, and there’s no guarantee that it will not return (Handel, 2014).
What are some common products for melasma?
Adapalene vs tretinoin for Melasma (vitamin A)
What is the difference between adapalene and tretinoin? Both of these ingredients are vitamin As and gold standards in dermatology. Retinoids are known for treating acne and scars, but they can also help with fine lines, wrinkles, and hyperpigmentation by making the skin resurface more quickly (Bandyopadhyay, 2009).
Adapalene and tretinoin both contain retinoic acid. Retinoic acid is also made naturally by our bodies, it’s super potent, and it is bioavailable. Bioavailable means that it can get straight to work without having to convert in the skin. However, vitamin A, especially tretinoin, can sting. Actually, about 50% have issues with tretinoin. Both retinoids help the skin to resurface, but there is a difference between them.
Adapalene gel is more gentle and compatible with other hyperpigmentation-fighting ingredients like kojic, mandelic, and azelaic acid. As a side note, melasma can occur during pregnancy, and fortunately, azelaic acid is pregnancy-safe. If you want to incorporate adapalene gel and a skincare acid into your skincare regimen, it’s better to use them at different times to avoid irritation (Sharkey, Lauren; Healthline, 2022). You can use them on different days, and remember to build your skin’s tolerance to retinoids as well by titrating. What’s also good about adapalene gel is that you can get it over the counter, and it does not degrade under light as easily (Bandyopadhyay, 2009).
On the other hand, using tretinoin with other acids could result in a considerable amount of irritation and even more hyperpigmentation depending on your skin type. But at the same time, it’s more powerful. This is not to say that tretinoin can’t be mixed with anything. There’s a common prescription for melasma that combines hydroquinone and tretinoin, but it’s at a very specific percentage (Bandyopadhyay, 2009). It’s essential that you speak with your physician to get an idea of what your skin can tolerate. If you have resilient skin, you’re not afraid of a little retinization, and you want something powerful for melasma, tretinoin might be right for you. But, you never know until you chat with a doctor. Although tretinoin is prescription only, you can use Dermatica to help you with a medical provider. They will help you assess your skin based on an online quiz. Whereas, if you go into an office, a doctor is actually going to look at you.
Kojic acid is an AHA that works by blocking tyrosine from forming which then prevents melanin production. Decreased melanin production can potentially lessen the intensity of melasma. Tyrosine is an amino acid that helps form pigment granules. When pigment granules are formed, they are transported to the upper layers of the skin. So, rather than getting rid of hyperpigmentation, kojic acid actually prevents it. You can couple kojic acid with a retinol and vitamin C as well. When put under a sunscreen, Vitamin C helps with free radical damage from UV radiation, a factor that can contribute to melasma. Secondly, retinoids help the skin form a new layer while kojic acid can prevent the overproduction of pigment granules.
Mandelic acid is an alpha hydroxy acid (AHA) used to exfoliate the skin. It's used to treat acne, hyperpigmentation, and aging skin. Mandelic acid loosens the lipids that hold dead skin cells together on the skin’s surface. After those bonds are broken up, the skin can shed more effectively. Overall, AHAs are wonderful for hyperpigmentation, but they can cause post-inflammatory hyperpigmentation sometimes. PIH can happen when the skin becomes a bit inflamed, and sometimes AHAs can be a bit sensitizing. Melasma is more common in skin of color patients, and so is PIH. Therefore, mandelic acid could be a helpful choice for higher Fitzpatrick levels (pigment levels).
However, what sets mandelic acid apart from its AHA cousins is the size of its molecules. Its molecules are larger than any of the other alpha hydroxy acids used in skincare. Its molecules are twice the size compared to glycolic acid. Fortunately, mandelic acid's larger molecules penetrate the skin much more slowly than its counterparts. This slow absorption means it's much more gentle and much less likely to cause skin irritation (Palmer, Angela; Verywell Health, 2022).
Melasma is a photosensitive condition, and likewise, it can be exacerbated by exposure to ultraviolet and visible light, making sunscreen use an essential component of treatment.
Once again, although these product suggestions can lessen surface melasma or prevent it from intensifying, real treatment can be found with a board-certified dermatologist who can examine and asses your skin.
This is not medical advice. Please consult a physician for your best treatment options.
Bandyopadhyay, Debabrata. Topical Treatment of Melasma.Indian J Dermatol. 2009
Handel, Ana Carolina. Miot, Luciane Donida Bartoli. Miot, Hélio Amante. Melasma: a clinical and epidemiological review. Brazilian Society of Dermatology. 2014. Fall 2014.