Melasma has shown to be more noticeable in the summer months, while improving during the winter. It has been recognized that many factors seem to trigger this condition (such as pregnancy, hormones, cosmetics, and certain medications), but most common is sun exposure to the skin. The ultraviolet light can increase melanin production, causing the skin to darken in color. Also, melasma has been documented that it can be inherited from family members, regardless of gender. While family history is not always the culprit, this form of hyperpigmentation has been shown to pass down in one-third of the family members who have experienced the condition.
Melasma is not a health condition. Its treatments are purely aesthetic and are intended to decrease possible embarrassment or distress for the client. Getting male clients to visit your spa to be treated for melasma may seem like a challenge due to their perceived notions about being treated for aesthetic purposes. In order to make them feel comfortable in the treatment room, it is important to educate the client and give proper advice on appropriate skin care routines that will help manage and treat the condition. Once a skin care professional is successfully able to communicate the various ways to treat melasma, it allows the male client instant gratification and may even score the professional a loyal client.
One of your loyal clients makes an appointment for her husband at your spa. Your client explains that she has always noticed grey-brown patches on his face, especially on the forehead, bridge of the nose, and chin. Concerned, she asked her husband if it caused any irritation but he did not seem concerned. She mentioned that she did a bit of research online and subsequently told her husband to stop using harsher products on his face (such as soap, aftershave or lotions) to help it clear. Unfortunately, it has been almost a year now with no signs of improvement.
The man is Caucasian, 45 years old, works as a landscape architect, and has not been on any medication. He has never had a spa treatment and seems a little apprehensive during the consultation. During this process, he mentions that he has previously experienced melasma – and that his family has a history of the condition – but it quickly went away the last time with no treatment. However, this time he started noticing the discoloration during the previous summer.
As a skin care professional, what solution do you propose to treat this case study?
Kathryn Khadija Leverette, L.E., owner of Clinically Clear Skin Rehab Center
“Melasma is usually associated with women and hormones, but 10 percent of those who get it are men. Those with darker olive skin and/or a genetic predisposition are more likely to get it. I see a lot of clients with melasma because I work with skin of color every day. Triggers include hormone changes, sun exposure, photo-sensitizing medications or skin care products and friction, including microdermabrasion. The fact that this client works in the sun, has a family history, and his melasma comes and goes with the seasons is no surprise.
Before any professional treatment, this client must understand that consistent use of a full-spectrum sunscreen is mandatory throughout the year, and he must be 100 percent compliant. Sheer high-SPF products that contain chemical sunscreens do not work well and will burn his eyes when he sweats. Give him two tubes or bottles of a greaseless SPF 30 sunscreen that contains micronized zinc oxide and/or titanium dioxide. Show him how to massage it in until the product is no longer visible. Explain that a liberal amount must be applied 15 minutes before he leaves the house every single morning, then reapplied every two hours while he is working – even on overcast days.
Once he is 100 percent compliant, have him try a melanin-suppressing skin brightener at bedtime. I like serums with brightening ingredients like kojic acid, alpha-arbutin, azelaic acid and niacinamide in a mild AHA base. Because of his prolonged daily sun exposure, steer clear of hydroquinone and retinoids. Make sure he applies a scant amount and massages it into the skin to avoid irritation. Caution him to never over use it and to never scrub his skin. Strong peels, microdermabrasion, scrubs and sonic brushes will make his melasma worse. I recommend mild lactic acid or enzyme peels in the total absence of irritation.”
Brenda Linday, L.E., L.E.I., director of sales and educational programs at VI Medical Products
“Review the client’s health history and conduct a thorough skin analysis using a Wood’s lamp to determine the depth of the pigment (epidermal, dermal or mixed). Educate the client about melasma addressing any concerns or apprehensions he may have. A dermatologist should assess the lesions to rule out conditions such as ochronosis or haemochromatosis.
For dermal or mixed melasma, lift pigment with medium-depth chemical peels that penetrate the dermis under the supervision of a physician. If the melasma is epidermal, opt to exfoliate the pigment with a series of superficial chemical peels.
Melanocyte suppressing ingredients are necessary in the professional treatment and daily care products used by the client. A broad spectrum sunscreen provides protection from future pigmentation. Ultraviolet exposure worsens melasma, so this patient should wear a hat and reapply sunscreen every 90 minutes to two hours when working outdoors.When dealing with melasma, remember... lift, suppress and protect.”
Aliesh Pierce, L.E., makeup artist, and author of Milady’s Aesthetician Series: Treating Diverse Pigmentation
“To be honest, I wouldn’t have much faith in my ability to cure his condition. I would probably ask when he last had his hormones checked. Men often experience melasma as a result of low testosterone. I would also ask about his diet. Often, what we interpret as melasma is actually rancid or rather oxidized fats or lipids that have experienced free radical damage. Perhaps adopting a more plant-based diet that is high in antioxidants would alleviate the issue.
After evaluating his skin under the Wood’s lamp, I may find that certain areas are barely identifiable. These areas signify that the melanocyte is pendulous, meaning that it extends deep into the dermis. This form of melasma is difficult to treat. However, I would recommend two weeks of pre-treatment with a salicylic wash, spot treatment with a retinol (tretinoin), an antioxidant serum, hydrating moisturizer, and lots of sunscreen. After a two-day break from these products, I would begin a series of peels using a lactic/kojic acid combination in two to four week intervals, depending upon his reaction. My suggestion for home care during the treatments would include a gentle cleanser and moisturizer. He will also need to stay out of the sun as much as possible, wear a double dose of antioxidant serum and sunscreen, plus protective clothing.”
Ahmed Abdullah, M.D., F.A.C.S., F.I.C.S., founder and formulator at Lexli International
“Given this client’s sun exposure, the first line of defense is protection. He must begin the frequent application of sunscreen and use of protective clothing to stop the worsening of the condition. These practices may, over time, allow the hyperpigmentation to lighten. However, to accelerate improvement, I would start him on a regimen that includes skin lighteners formulated with kojic acid and/or hydroquinone. If the hyperpigmentation is severe, I may also incorporate the use of tretinoin or a corticosteroid, which are proven beneficial in stubborn cases. There is no need to stop using soap, aftershave or lotions, as these products do not contribute to the condition.”
Courtney La Marine, L.E., owner of Clove Studios
“First and foremost, I would recommend the daily use of a sunscreen with an SPF 30 or higher. I would also recommend wearing a protective hat while working outdoors at all times. As far as treatment recommendations, microdermabrasion or a chemical peel series will definitely improve the tone and texture of the dark spots. Winter is a great time to treat hyperpigmentation and allows for less sun exposure. Normally a series consists of five to six treatments and can dramatically reduce hyperpigmentation and improve the overall health of the skin. Since most men generally like to keep it simple, I would recommend a cleanser and moisturizer with vitamin C (which helps repair hyperpigmentation and free radicals) and an SPF.”