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Melasma is a condition in which stubborn patches of discolorations, darker than the natural skin tone, crop up on the face. It is often associated with hormonal swings and is sometimes called “the mask of pregnancy” because of the frequency with which pregnant women (including me!) develop it during gestation. However, it occurs frequently in men as well, and it’s more likely in deeper skin tones than in lighter ones.
Melasma is not hyperpigmentation, which is a darker discoloration that occurs as a result of trauma to the skin. It’s also not exactly the same as sun damage, which is darker discolorations that crop up at random after years of sun exposure, though it is believed that sun exposure plays a role in melasma developing. However, treatment for melasma, sunspots and hyperpigmentation are all similar. Once they’ve developed, your goal is to remove them in one of two ways: a product that speeds skin turnover, or a product that inhibits the production of melanin, which produces the color in skin. Using these products with your dermaroller can lead to additional benefits.
First: there’s some modest evidence that dermarolling all by itself, without any actives or special ingredients, can improve melasma or hyperpigmentation. So everything that follows here is talking about add-ons and extras.
This post will explore three ingredients referenced in different papers, discussing how they’re used and what the outcomes were like. I always link to the research, and whenever possible I select sources that are freely available through PubMed or ResearchGate.
First: with all three ingredients, two things are most important:
- You have to wear sunscreen. I know. These ingredients are irritating, and some of them are photosensitizing (I’ll note which ones), meaning they make your skin more sensitive to the sun. You are not doing all this work and buying these products just to go out and make your melasma worse. You love yourself more than that.
- You have to patch test. Before you check to make sure that these products are going to work for you, you have to make sure that they’re not going to damage or irritate your skin. This is doubly important if you are prone to post-inflammatory hyperpigmentation, scarring or keloids. Here’s my post on how to patch test actives with a dermaroller.
Both of these are mandatory to your success here.
Vitamin C: Cheap and Probably Good
This study is brand new (like, it was published 17 days ago as of my writing this post), it’s a small pilot study and it’s the only one studying this as far as I can find. So, take it with a grain of salt. However, there are lots of anecdotal accounts online of people using Vitamin C with dermarollers, and this is going to be the only inexpensive, non-prescription option for products here.In this study, patients received a microneedling session followed by application of Vitamin C in its L-Ascorbic Acid form every two weeks for three months. Patients saw about a 30% improvement in the appearance of symptoms over these six weeks.
Let’s talk about the benefits and drawbacks here. These outcomes are modest, and patients benefitted unevenly: fair-skinned patients saw more improvement than deeper-skinned patients. This is also the only one of the three ingredients discussed in this post where anyone saw a recurrence (their melasma coming back), probably because Vitamin C is not a melanin inhibitor. However, the good stuff is pretty good! Vitamin C is cheap and readily available (the next two ingredients definitely are not) and can be used between treatments without much irritation.
The study used a 20% L-AA, like this Dr. Brenner brand serum* that also comes with soothing, hydrating hyaluronic acid. The conclusions section of this study note that it might be best as a maintenance treatment, but if you’re a fair-skinned person looking to try this out on the cheap, Vitamin C may well be worth a shot.
Tranexamic Acid: Effective and Expensive
Tranexamic Acid is the hot new thing at the moment, and the research is very new. TA is primarily used to promote blood clotting; however, that same function can be used to inhibit melanin from causing discoloration in the skin in the form of sunspots and melasma.
Two sources here. First, a lit review: (Zhang et al 2018) documenting the general effectiveness of tranexamic acid in the treatment of melasma; they perform a meta-analysis of 21 other papers and find that tranexamic acid does have good outcomes for melasma. Across these studies, the patients consistently improve MASI scores, which measure how much of the face is covered with discoloration. One important note: many of these papers use oral administration of transexamic acid–like as a pill–and that had some serious side effects. Several of these studies report female patients who missed menstrual periods or became irregular because of the clotting function of TA, which is serious! If you live somewhere where you can get it over the counter and wish to try anyway, these studies used, on average, 250 mg/day of oral TA.
Of more interest to us here in dermaroller-land, a second paper compares microinjections of transexamic acid to applying TA after microneedling. It’s worth noting that this one is an RCT that only accepted people with what’s called recalcitrant melasma, meaning they had already tried another treatment method and it hadn’t succeeded. So, these are the tough cases. In this study, both groups receive TA, but one group gets it through microinjections and one group gets it in the form of a serum after dermarolling. After three sessions, 41% of the microneedling group have seen greater than 50% improvement in the severity of their discolorations, compared to 26% of the microinjection group. And, remember, these are the most stubborn patients–we could generalize that success rates would likely be higher in a general group of melasma sufferers.
As far as what’s available on the market with transexamic acid: it’s expensive. SkinMedica Lytera Pigment Correcting Serum* has it, but it’s a steep price tag. Since the research is so recent and the buzz is just beginning about this ingredient, I hope that more midrange brands will be putting out transexamic acid products soon (cause, uh, that price is not working for me either!).
Tri-Luma: Prescription Solutions (in some places!)
Tri-Luma is a combination of hydroquinone, a bleaching agent, tretonin, a retinoid, and fluocinone, a corticosteroid that reduces itching. This stuff is no joke, so let’s get the negatives out of the way: in many countries hydroquinone is banned under suspicion of being carcinogenic, and even if you can get it you can’t use it for more than three months at a time. Tret has a seriously harsh adjustment period for most people. This is not your first choice. Tri-Luma requires a prescription in the US.
That being said, (Lima et al, 2017) did a pilot study of 30 women. As in the previous study, all of these women had tried another melasma treatment previously and had no success. They received a session of microneedling, then the next day used Tri-Luma. Patients received just two such treatments and reported an average of 70% decrease in their MASI score (that measure of how much of the face is covered and how dark the discoloration is). It appears to me that the Tri-Luma is used daily between sessions, but the translation is a little ambiguous on that front. Home dermaroller users can, of course, easily continue past two treatments and pursue even greater improvements.
Long post! Melasma protocol tomorrow. 🙂