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At a women’s networking dinner the other night in midtown, I was introduced to a lively blonde restaurant publicist over white wine and a multi-course meal. Our conversation quickly turned to the usual things—work, children, and, of course, skincare. “What is this,” she asked me using her index finger to circle a cluster of pigmentation on her right cheek that was barely perceptible under the dim lights. Despite what the vast majority of friends, family, and new acquaintances may think, being a beauty editor does not make me a dermatologist; but I recognized the discoloration and the symptom onset she described. “It’s probably melasma,” I told her, receiving what is a fairly reliable response to this kind of assessment: “What’s that?”
“Melasma absolutely falls in the bucket of discoloration and hyperpigmentation,” explains Shereene Idriss, M.D. adding that dark spots, which can be caused by everything from sun damage to post-acne inflammation, present a “massive umbrella” for a range of more finite diagnoses. But melasma is specific—and specifically challenging to treat, says the Manhattan-based dermatologist, as it can be triggered by the sun, but also by heat, hormones, menstrual cycle fluctuations, pregnancy, birth control medication, and even stress. “When you have a sun spot, it is what it is. It's not going to get better and worse over time on its own. The actual morphology of the lesion is different with melasma,” Idriss continues, describing its appearance as "patchy," with edges that are ill-defined.
Most doctors are able to identify melasma through pattern recognition and clinical history; but for Idriss, who is more commonly known as “PillowtalkDerm” by her nearly 500,000 Instagram followers, personal history has played a big part in her experience treating the condition. While pregnant with her second child in 2019, Idriss had a major flare up. “Once he came out, it went wild, so on top of being postpartum and being hormonal and being slightly down, this happened. It was like a punch to my gut,” she recalls. But it was also the perfect catalyst for her first foray into skincare products under her newly minted PillowtalkDerm brand.
Called Major Fade, the three piece collection, which launched this week, includes a serum, mask, and a gel-cream to help treat melasma with a cocktail of clinically-proven ingredients designed to exfoliate and brighten dark spots, including glycolic acid, lactic acid, tranexamic acid, kojic acid, arbutin, and vitamin C. Idriss is the first to admit that topical products—even very targeted ones like her own, which were formulated by an in-house chemist and focus-group tested by 600 people from her online community over a one month period—can only do so much when it comes to melasma. “Obviously prescriptions can never really be replaced,” she says, noting that prescription-grade hydroquinone and oral tranexamic acid, in addition to in-office peels and select lasers, are still the gold-standard when it comes to “clearing” melasma. But over-the-counter products provide that “bridge to good skin,” she insists. “You have to consistently be addressing the pigment pathway — even when it's under control—because you don't know when it's gonna flare up.”
Melasma’s unpredictability, and its links to inflammation possibly caused by stress is of particular interest to Evan Rieder, M.D. a New York-based dual-certified dermatologist and psychiatrist. “An emerging concept, which I don't think has been widely accepted in the field of dermatology yet, is the idea that psychological stress or oxidative stress may have a role in the development the pathogenesis of melasma,” says Rieder, reiterating how difficult it can be to treat the condition. There is no empirical evidence to support this idea as of yet, he admits, but “decreasing stress, regardless of what else you're doing, is probably going to help any sort of inflammatory skin condition.”
In the meantime, and in lieu of a totally stress- and UV light-free lifestyle, Rieder relies on salicylic acid peels and microneedling combined with topical tranexamic acid serums to treat flare ups at his downtown practice, as well as Tri-Luma, a prescription medication that combines retinoids and hydroquinone to prevent pigment from developing as well as a steroid to cut down on any irritation. Sunscreen can be an equally important tool in the melasma arsenal—even if you work in an office all day, advises Rieder. “People tend to be more laissez-faire about sunscreen use when they have an indoor job but with melasma, it's a different story,” he says, recommending reapplication, especially if you sit next to or near a window. In other words, pick your melasma fighters wisely; here, an edited list of mighty contenders.
