There are many factors that can contribute to the onset of melasma, including genetics and hormone fluctuations, but as anyone dealing with a melasma mustache knows, it’s a concern that is increasingly difficult to deal with over time. While packing on the foundation and concealer can be a simple quick fix, doctors says it takes time, patience and consistency to say goodbye to the dark, hard-to-miss shadow above the upper lip.
What Triggers Melasma
According to Bloomingfield Hills, MI dermatologist Linda C. Honet, MD, melasma is caused by a combination of hormones and genetics and is triggered by both heat and sunlight. “The challenge is that melasma is a complex, multifactorial condition and there may be underlying factors that we have yet to elucidate and understand. Underlying the pigmentation is a fine vascular network that may in fact ‘feed’ and support the pigment network and may have a more significant role than we know.”
The main melasma trigger is hormonal. “It is usually brought on by pregnancy and birth control pills, plus sun exposure,” says Saddle Brook, NJ dermatologist Dr. Frederic Haberman. “No matter what the treatment is, adequate amounts of sunscreen must be used at least 30 minutes prior to sun exposure and reapplied every two hours.”
“It can be a beast to treat, so hats, sunglasses and sunscreen are a must to prevent—especially if you are on hormones,” adds Prospect, KY dermatologist Tami Buss Cassis, MD.
Oral + Topical Remedies
Fort Lauderdale, FL dermatologist Dr. Matthew Elias says sunscreen and hydroquinone are still the gold standard for treatment. “Sometimes we also have to have old school Tri-Luma topical cream compounded with 6- or 8-percent hydroquinone and have patients jump-start treatment with that for two months.”
“For a melasma mustache, I recommend beginning treatment with Retin-A co-inventor Dr. Albert Kligman’s original compound which includes hydroquinone, Retin-A and triamcinolone, which is referred to as ‘triple bleaching cream.’ Since melasma mustaches can be difficult to treat, remember that patience is a virtue,” adds Dr. Elias.
“Sunscreen and sun protection,” says New York dermatologist Doris Day, MD. “I also like Heliocare Dietary Supplement ($30) to enhance UV protection or ISDN’s new SUNISDIN Softgel Capsules ($50). Also try to avoid birth control or any hormonal therapy. For skincare, I recommend Even Tone Correcting Serum ($140) by Skinbetter Science twice daily and hydroquinone 4 percent on top of it at night, or if you’re pregnant, Glytone Brightening Complex ($74).”
Davie, FL dermatologist Marianna Blyumin-Karasik, MD says her favorite skin brightener to treat melasma is the intesnive pigment corrector Cyspera. “I love it because it is a medical-grade pigment corrector, so it lightens in a balanced and even way and does not leave blotchy hypo- or hyperpigmentation, in contrast to other bleaching agents like hydroquinone. It is a new, safe, and effective antioxidant that can be used as a short contact 15-minute daily mask daily for various pigmentation disorders.”
Dr. Honet says oral antioxidant supplements like the fern extract polypodium or a topical milk thistle derivative called silymarin may be helpful, too.
In-Office Treatments
As far as zapping the melasma with a laser, that part is tricky. The dermatologists we spoke to all said chemical peels are the go-to in-office treatment, but certain lasers can also help minimize or eliminate the mustache. But many lasers can make melasma worse, so it’s important to go to a board-certified doctor who can guide you to the right procedure. “I like to do chemical peels, like the VI peel, and alternate with the PicoWay laser,” says Dr. Day.
“Excellent results can be seen for melasma by combining a thulium laser, like Fraxel or Permea, and a Pico laser like the PICO Genesis FX,” adds Dr. Elias.
Dr. Haberman notes that a laser treatment may not be the first option he would choose for treatment and advises sticking to topical solutions. “I would avoid Fraxel, Permea and Pico laser as early treatments and be very patient while treating this problem,” he advises. “If after at least 60 days the response to treatment is poor, I would perhaps change to a double bleaching preparation containing 1 percent kojic and azelaic acids, which can also be compounded with 5 percent niacinamide.”
No matter the treatment approach, there are viable solutions available, it’s just a matter of finding which one works best for you. If there is one thing all of the skin-care experts we spoke to stressed, it was that melasma is extremely hard to get rid of without consistency and dedication to a treatment plan and a commitment to avoid the sun.
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