Melasma is a commonly acquired increase of pigmentation that occurs exclusively in sun-exposed areas. Brownish in color, it is exacerbated by sun exposure, pregnancy, oral contraceptives, and certain anti-epilepsy drugs.

Melasma is reasonably common, especially in women of child-bearing age. However, up to 10% of cases have been reported in males. While all races are affected, there is a prominence among Latinos and Asians. Melasma is more apparent during and after periods of sun exposure and less obvious in winter months, when sun exposure is lacking.

Melasma presents itself in one of the three usually symmetrical facial patterns. The most common is a centrofacial pattern involving the cheeks, forehead, upper lip, nose, and chin. Less common are the malar pattern, involving the cheeks and nose, and the mandibular pattern, involving the ramus of the mandible (the side of the cheeks and jaw line). Melasma also occurs on the forearms, but this is rare.

What is the Difference between Dermal and Epidermal Melasma?

Every case of melasma starts off in the epidermis, where melanocytes are actively producing pigment. A normal case of melasma can turn into dermal melasma if skin becomes over-irritated and inflamed. When this happens, it causes a temporary split between the dermis and epidermis. During this time, hyperpigmented cells can drop from the epidermis into the dermis. Once in the dermis, these cells become very resistant to topical treatment. This is one reason why it is so important to avoid aggressiveness in the treatment of melasma.

What are the Causes of Melasma?

Melasma has been considered to arise from pregnancy, oral contraceptives, endocrine dysfunction, genetic factors, medications, nutritional deficiency, hepatic dysfunction, and other factors. The majority of cases appear to be related to pregnancy or oral contraceptives. The infrequency of melasma in postmenopausal women on estrogen replacement suggests that estrogen alone is not the cause. In more recent experience, combination treatment using estrogen plus progestational agents is being used in postmenopausal women, and melasma is being observed in some of these older women who did not have melasma during their pregnancies. Sun exposure would appear to be a stimulating factor in predisposed individuals. Although a few cases within families have been described, melasma should not be considered a hereditary disorder.

Treatments for Melasma

Hydroquinone
Hydroquinone is the most popular, and is also the most effective topical hypopigmenting agent. Hydroquinone works by inhibiting the conversion of tyrosine to melanin, inhibiting the formation of melanosomes and increase the degradation of melanosomes, and by inhibiting the DNA and RNA synthesis of melanocytes.

As a result, only cells with active tyrosinase activity are affected by HQ. Active tyrosinase activity is only found in epidermal melanocytes. In dermal melanin, tyrosinase activity is not present; therefore dermal melasma is resistant to hydroquinone. The efficacy of hydroquinone is related to the concentration of the preparation. Preparations with a hydroquinone concentration of 2% or less do not require a prescription, but are much less effective than prescription counterparts and are only recommended for maintenance therapy. Concentrations of 5%-10% hydroquinone are very effective, but can be irritating. The chemical stability of hydroquinone formulations is important because HQ is easily oxidized and loses potency. HQ formulations should be kept in small, dark bottle of no larger than 1 ounce and should be used within 30 days.

The lightening effect of hydroquinone can be enhanced by combining it with other agents such as alpha hydroxy acids and tretinoin.

Side effects of hydroquinone include irritation, possible allergic reactions, nail discoloration, postinflammatory hyperpigmentation (dark spots), and temporary lightening or depigmentation of treated and surrounding skin. These side effects are temporary and will resolve when the HQ formula is no longer used. There is one other possible, and rare, permanent side effect known as ochronosis. Ochronosis is a permanent gray or blue-black discoloration occurring in very dark-skinned or African American patients after prolonged treatment with an HQ formula with an HQ concentration greater than 3%.

Tretinoin
Tretinoin (Retin-A, Renova) is another widely used therapy for melasma. Tretinoin does have a lightening effect on melasma and can be used alone or in conjunction with HQ. Tretinoin works by promoting the rapid loss of pigment via increased epidermopoiesis, easing penetration of HQ into the skin, and preventing HQ oxidation.

Kojic Acid
Kojic Acid is derived from a variety of different fungi and organic substances (such as soy and mushrooms). The current belief is that kojic acid suppresses free tyrosinase by the chelation of the copper ion. Kojic Acid has been known to cause contact allergies in a small number of people. Kojic Acid has an ester that may be more effective and less irritating than kojic acid itself. One therapeutic ester is kojic dipalmitate. The exact mechanism of action of kojic dipalmitate is not known except that it is a tyrosinase inhibitor.

Azelaic Acid
Azelaic Acid is a dicarboxylic acid that is derived from cereal grains such as wheat, rye, and barley. The depigmenting action of azelaic acid is related to its inhibition of tyrosinase, the enzyme necessary for melanogenesis. The clinical efficacy of an azelaic acid 20% with glycolic acid 15% cream was compared to a 4% hydroquinone cream. The results revealed equivalent reduction of the pigmentation in both groups, with a slightly greater irritancy rating with the group that used the combination of the azelaic acid and glycolic acid.

Azelaic acid may take several months to be effective as a depigmenting agent. Hydroquinone should be discontinued after prolonged use due to a plateau of efficacy and to avoid the possibility of ochronosis. Azelaic acid would make a good alternative to hydroquinone for continued therapy. A small percentage of patients may, however, experience some itching or burning.

Arbutin
Arbutin is an extract of a bearberry plant and derivative of hydroquinone. It can inhibit the formation of tyrosinase while also preventing oxidation of hydroquinone. This is a popular treatment in Japan, where hydroquinone is unavailable.

N-acetyl-4-cysteaminylphenol
N-acetyl-4-cysteaminylphenol is a depigmenting agent that acts on functioning melanocytes with minimal side effects. It has shown good results in a 4% formulation, and is more stable and less irritating than hydroquinone. In one study, 75% of the cases showed improvement.

Licorice
Licorice also helps inhibit tyrosinase activity and can be used with HQ or tretinoin.

Vitamin C
Vitamin C can be combined with other melasma treatments for enhanced results. It can fade melasma from a dark black to light tan while also providing additional protection from the sun. In one study, 55% of the cases showed improvement after 5 months on a 10% formulation.

Mandelic Acid
Mandelic Acid, an alpha hydroxy acid derived from the bitter almond, has been shown to have a lightening effect on melasma. Its most important aspect is its ability to fade dermal melasma, which has long been known to be resistant to topical therapies. The majority of melasma cases are a combination of dermal and epidermal melasma. The best results are gained on this type of melasma when mandelic acid is combined with a hydroquinone or other bleaching formula. It is also effective when used alone and is a great alternative for those who are sensitive to hydroquinone or for those who hyperpigment easily.

Sunscreen is the most important factor for successful treatment. Without daily use of opaque sunscreen, treatment will fail. A broad-spectrum formulation with an SPF over 30 plus cover up is adequate. Look for sunscreens that contain PARSOL 1789 or avobenzone, Zinc Oxide, and/or Titanium Dioxide. Make sure the formula is sweat proof if you plan on being in the sun for long hours.

Normally up to 2 months are required to begin to initiate response and up to 1 year to complete the process. Once epidermal melasma is cleared and is no longer apparent with Wood's lamp examination, the hydroquinone and tretinoin should be discontinued. However, the opaque sunscreen should be continued through at least one summer season to reduce the risk of recurrence. Often, melasma will slowly resolve following childbirth or upon discontinued use of oral contraceptives.

Dark Skin

Why Does African American Skin Need Special Care?

Due to the close distribution of melanocytes in darker skin types, irritation and swelling can cause the melanacytes to react and produce pigment. When this happens, it can cause dark pigmented spots appear. It is commonly known as post-inflammatory hyperpigmentation. The largest concern for people of African descent is uneven skin tone - and this is most likely due to to an inflammatory reaction in the skin.

This problem can be difficult to treat because most traditional methods of skin lightening will cause further irritation and furtherhyperpigmentation. Glycolic acid, hydroquinone, retinol - these should all be avoided due to their irritation potential (especially since higher concentrations are needed in order to produce significant results).

The MaMa Lotion Difference

The MaMa Lotion solves the problem by addressing two issues - the need for high potency and hyperpigmentation prevention. MaMa Lotion combines two alpha hydroxy acids that are known for their non-irritating nature, mandelic acid and malic acid, with potent antiinflammatories. This unique combination ensures maximum results with minimal irritation.

In order to achieve significant results within a reasonable amount of time, higher concentrations of active ingredients have to be used. The MaMa Lotion has a combined strength of 20% AHA, but the main source of its power comes from its low 2.5 pH. The lower the pH, the more active the acids are in the formulation. This low of a pH is usually reserved only for peels performed in a dermatologists office (most at-home products have a pH between 3.5-4.0). Because of the mandelic/malic/anti-inflammatory combination, the MaMa Lotion, even with its high activity, can be used safely and effectively on darker skin tones.

Beyond Hyperpigmentation

MaMa Lotion provides benefits for the skin beyond just evening out skin tone. MaMa Lotion will also help to increase collagen production in the skin.

In the initial studies performed by Dr. Van Scott and Dr. Yu (the discoverers of alpha hydroxy acids), they found that higher concentrations of alpha hydroxy acids provided benefits beyond just surface exfoliation. In AHA concentrations of 20% or more, they found signs of increased collagen production within the skin. At a concentration of 20% AHA, MaMa Lotion is able to provide these same collagen promoting benefits - without the irritation and redness that Retin-A or Renova can cause.

MaMa Lotion will also help to slow down and prevent breakouts in oily/acne prone skin types. This is due to the increased exfoliation and the natural antibacterial qualities of mandelic acid.

What Should I Expect From MaMa Lotion

Within a month of using MaMa Lotion every other day, you will see a significant improvement in the clarity and color of your skin. Pigmented areas will be greatly improved and the overall texture of your skin will be softer and smoother. Within two months of use, you will also notice a significant decrease in the number of blemishes. If you are still breaking out, you will find that the blemishes will be greatly reduced in size - and the marks they leave behind will vanish even faster than before. Darkly pigmented areas on the body will start to peel and will leave behind smooth, flawless skin.

Recommended use depends completely on your individual skin and what it can tolerate. Because of its high activity, it is recommended that you start off using it only once every other day. This will help determine skin sensitivity and will help minimize peeling. After a few weeks, if there is no excessive peeling or stinging with product application, you can increase the frequency of application. It is always better to take it slow. If you find yourself becoming sensitive, then you should take a break for a week or two, then start again, applying the MaMa Lotion less frequently than before.

(Please Note: Application of the MaMa Lotion will always be followed by a sharp stinging sensation. There is no reason to be alarmed as long as the stinging dissipates within 30-40 seconds. The initial sting is cause by the acids entering the skin. Prolonged stinging and itching signifies sensitivity to the product).

Benefits of Mandelic Acid

• Naturally anti-bacterial. One of the main contributing factors to inflammatory acne is bacteria. This natural property of mandelic acid aids in preventing the appearance of new, unwanted blemishes.
• Absorbs and controls oil
• Gentle penetration helps protect against irritation, which can cause more redness and more scarring

Benefits of Malic Acid

• Natural humectant, which draws water out of the dermis and into the epidermis. This helps keep the skin hydrated, without contributing to oiliness
• Natural antioxidant properties help fight free radicals in the skin - which can contribute to skin damage.
• Gentle nature makes it suitable for use on sensitive skin, even in high concentrations.

Benefits of Algae Extract (the marine-derived anti-inflammatory)

• Inflammation is the direct cause of the scarring. Anti-inflammatories allow the skin to begin to heal itself. It is also important in the prevention of new scarring.
• This particular form of algae extract is known for its non-irritating and non-comedogenic moisturization qualities (some forms of algae extract are not so beneficial)
• Helps provide additional protection from irritation.

What Should I Expect From MaMa Lotion

Within a month of using MaMa Lotion every other day, you will see a significant improvement in the clarity and color of your skin. Pigmented acne scarring will be greatly improved and the overall texture of your skin will be softer and smoother. Within two months of use, you will also notice a significant decrease in the number of blemishes. If you are still breaking out, you will find that the blemishes will be greatly reduced in size - and the marks they leave behind will vanish even faster than before.

Recommended use depends completely on your individual skin and what it can tolerate. Because of its high activity, it is recommended that you start off using it only once every other day. This will help determine skin sensitivity and will help minimize peeling. After a few weeks, if there is no excessive peeling or stinging with product application, you can increase the frequency of application. It is always better to take it slow. If you find yourself becoming sensitive, then you should take a break for a week or two, then start again, applying the MaMa Lotion less frequently than before.

MaMa Lotion 2.5 PH Gel
The Ultimate AHA Gel with Mandelic & Malic Acid

Product Information

MaMa Lotion is a revolutionary alpha hydroxy acid gel that combines two unique alpha hydroxy acids: mandelic acid and malic acid. Mandelic acid and malic acid are alpha hydroxy acids with a slightly larger molecular structure. This results in a slower, more even penetration and less irritation. This allows people normally unable to tolerate high concentrations of AHAs to enjoy the collagen promoting benefits of an AHA peel.

The MaMa Lotion Advantage

Mandelic Acid and Malic Acid have unique beneficial properties that are not found in glycolic acid.

Mandelic Acid is naturally anti-bacterial. This property provides an additional aid in fighting unwanted breakouts - and is especially useful for those combatting adult acne.

Malic Acid is a natural humectant, which draws water out of the dermis and into the epidermis. This helps keep the skin hydrated throughout the day. Malic Acid is also a known antioxidant. In addition to its exfoliating and moisturizing properties, malic acid can help protect the skin against free radical damage due to sun and pollution exposure.

You may have noticed that the pH level of the MaMa Lotion is significantly lower than other AHA products (which typically range from 3.5-4.0). This is possible due to the non-irritating properties of mandelic acid and malic acid. It is also important because it allows for greater penetration and exfoliating activity - much like an in-office AHA peel.

Who Should Use MaMa Lotion

Almost anyone who desires firmer, brighter, softer, and more even skin should use MaMa Lotion. It is even recommended for those with sensitive or darker skin tones. You should avoid use of the MaMa Lotion if you suffer from unusually sensitive skin or eczema (on the face).

Recommended use depends completely on your individual skin and what it can tolerate. Because of its high activity, it is recommended that you start off using it only once or twice a week. This will help determine skin sensitivity and will help minimize peeling. After a few weeks, if there is no excessive peeling or stinging with product application, you can increase the frequency of application. It is always better to take it slow. If you find yourself becoming sensitive, then you should take a break for a week or two, then start again, applying the MaMa Lotion less frequently than before.