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- What causes melasma?
- Common causes of hormone imbalances
- Estrogen Dominance
- Drug-related hyperpigmentation
- 3 essential tips before you do anything else
- Supplements to consider when treating Melasma
- Comments from readers
What is Melasma?
Melasma is a skin condition where brown pigmentation forms on the cheeks, around the eyes, on the forehead, or above the lip.
While anyone from light-skinned redheads to dusky brunettes can develop it, it is more common among darker skin types and people who have the ability to tan easily like South Asians, Hispanics, and Italians. It also affects both men and women.
What causes Melasma?
It is often difficult to pinpoint the exact cause of melasma as it varies from person to person. Below are some of the known causes:
- - Changes in hormone levels
- - Waxing of facial hair
- - Allergic reactions and inflammations from skincare products
- - Excessive sun exposure and tanning
- - Drug interactions
If you are looking to clear your melasma, the first step is to pinpoint the cause. Once you figure out the cause, you can find the appropriate ways to tackle the problem at the root.
The best people to answer this is your doctor — who can test your levels of estrogen and progesterone — and you — since you can trace back to when your melasma first started and what you did before (i.e. medication/lifestyle/diet/habits).
For now at least, I will focus on the most common cause of melasma – hormone imbalances.
Common Causes of Hormone Imbalances
Hormonal changes due to pregnancy is perhaps the most common cause (in fact, melasma is sometimes referred to as the pregnancy mask).
However, you don’t need to be pregnant to have your hormone levels be out of whack these days. Unfortunately, we are bombarded by chemicals, pesticides, and food additives that can easily have the same effect on our hormones. These compounds are called xenoestrogens.
Apart from pregnancy, melasma due to hormonal changes can be due to causes like:
- Taking birth control pills. Read user accounts which ties specific brands to their melasma
- Excessive copper levels in the body. Copper is closely related to the metabolism of the estrogen hormone.
It is interesting to note that the third cause—an excess of copper—can also be related to pregnancy. Copper levels are usually elevated in pregnant women as the mineral is needed to form new blood cells for the foetus.
If you are on a vegetarian diet, it is likely that your copper levels are also elevated because of the type of proteins you ingest.
Hormone Imbalances or Estrogen Dominance
The subject of estrogen dominance is a tricky one.
If you have time to spare, I suggest reading up on the information found here. The page describes estrogen dominance at length and will be useful for anyone seeking more in-depth knowledge on the matter. It also discusses several methods to detoxify your body of excess estrogens.
Also read Jane’s story, which is a case study of a woman that has struggled with the issue all her life. What struck me was that at one part of her tale, she describes that “hyper-pigmentation would appear on her face whenever she had her periods”. Although melasma is never mentioned in these pages specifically, Jane’s comment is no doubt too similar to the condition related to melasma to ignore.
I’ve summarised several significant points from the site below:
For optimum health, the progesterone to estrogen ratio should be between 200 – 300 : 1.
Stress increases your estrogen levels. Progesterone is necessary to counter estrogen levels lest they become too high. Among the things that reduces your progesterone output is stress.
Countries with higher obesity rates tend to show more incidence of estrogen dominance in the population. All body fat has an enzyme which converts adrenal steroids to estrogen, so the more fat you have, the more estrogen is present. However, plants contain over 5,000 known sterols that have progestogenic effects (counteracts estrogen), so a switch to a healthier, more plant-based diet will help lower estrogen levels.
Taking drugs and alcohol may contribute to higher estrogen levels as these impair the liver which is the main organ that breaks down the estrogen hormone. This also means that taking herbs/supplements that aid in liver function will detoxify the body of too much estrogen. A sterling example is milk thistle (silybum marianum), which has been proven to fortify the liver. The dosage for milk thistle is 70 to 200 mg one to three times a day.
Vitamin B6 and magnesium are needed to neutralize estrogen in the liver. Thus, a deficiency may increase the levels of estrogen in the body. It also becomes something of a self-perpetuating cycle, as too much estrogen leads to a deficiency of zinc, magnesium and the B vitamins.
When eaten, the hormones, drugs, and antibiotics fed to cattle and poultry can wreck havoc to estrogen levels. Fish are far superior to beef or chicken in terms of hormone load.
Women who drank four to five cups of coffee daily had nearly 70% more estrogen than women who consume less than one cup of coffee. Tea is not much better. And for that matter, neither are soft drinks with caffeine in them like Red Bull or Mountain Dew.
As I did more research on the subject of estrogen imbalances, more things kept coming up. Most notable and perhaps most worryingly, is the effects of soy on hormone levels.
Soy alters hormone levels two ways:
1) Soy blocks the absorption of calcium, magnesium, copper, iron, and zinc in the intestines. These minerals are neccessary for healthy hormone levels.
2) Soy has high amounts of phytoestrogens. These are chemicals produced by plants that act like estrogens in the human body.
It is false to assume that taking large amounts of soy is healthy and good for you as “Asians eat soy as a staple” – this is what soy manufacturers want you to believe. Rice is a staple there, not soy. In Asia, soy is used mostly as a condiment (soy sauce is popular in cooking and has many forms in Asia). And when tofu is eaten, it is usually a side dish in Asia, not a main one.
Other popular soy products in Japan and South East Asia are miso and tempeh. However, these are heavily fermented forms of soy, which are safe and do not block the minerals necessary for healthy hormone levels.
I wouldn’t say that soy is evil, but anything in excess is bound to be bad for you. Thus, if soy is in your diet, take it in moderation only.
Update: There seems to be two schools of thought on this (perhaps more).
Blossom shared her thoughts on soy, “The isoflavones in soy attach to the body’s estrogen receptors and create a mild estrogenic effect, even in the presence of excessive natural estrogen, therefore soy can actually balance the effect of estrogen in the body if there is too much in circulation.”
If anyone has more helpful information on soy and/or differing opinions, please drop them in a comment and I’ll add them here.
Linda, a vegan, shared that the melasma on her upper lip improved after switching from soy milk to almond milk and lightening her soy intake.
Warning on Drug-related Hyperpigmentation (Oral Antibiotics, Anti-Depressants)
Prolonged use of some drugs have been proven to cause hyperpigmentation for some people.
Because of its prevalence and widespread use, the most common culprits are oral antibiotics like minocycline (usually used to treat acne and pemphigus), tetracycline, and doxycycline.
The antidepressant imipramine, the heart medication amiodarone (to treat arrhythmias), bleomycin and cyclophosphamide (cancer drugs) have also been proven to cause hyperpigmentation in some users.
The list goes on to include chlorpromazine (an anti-psychotic) and phenytoin (for epilepsy).
Drug-related hyperpigmentation can occur both externally on the skin, teeth, and gums, as well as internally on the organs and bones.
On the skin, dark patches may occur on the face, arms, and legs, among other areas. Often, drug-induced hyperpigmentation is made worse by prolonged exposure to the sun.
Hyperpigmentation on the skin caused by the acne medication minocycline may start occuring from as early as one month to as late as 25 months. For further reading on this drug and the studies conducted, click here (a pdf file will open).
[On a separate note, another side effect of taking oral antibiotics like minocycline regularly is candida. If you have candida, you should consider taking yogurt, fermented food, or probiotic supplements to heal yourself. ]
The good news is that drug-related hyperpigmentation will often improve after some time once the person stops taking the medication.
3 essential tips before you do anything else
Firstly, be prepared that the road to righting your hormone imbalance is a process that may take several months.
Secondly, be encouraged that while melasma is a difficult condition to live with, you are not alone. Find a friendly forum and other people with melasma to share your thoughts, questions, support and progress with.
Here are a few forums and discussion threads on melasma to get you started:
Thirdly, be gentle. If you have melasma, the chances are high that aggravating your skin with harsh chemicals and scrubbing will only darken the melasma. For some, melasma even darkens from external heat, such as a hot bath or using a hair curler or dryer.
Important supplements to right hormone imbalances that cause melasma:
- Vitamin C
- Probiotics (good bacteria)
- Calcium D-Glucarate
Why do these supplements help?
Both Zinc and Vitamin C help lower copper levels, while MSM increases the permeability of cells allowing the copper to easily move out of the body as waste. CoQ10 helps to boost cell turnover.
The liver breaks down estrogen and sends it to the intestines to be eliminated, but once there, bad bacteria can re-convert it back to estrogen. Good bacteria like L. acidophilus helps prevent this from happening by competing with the estrogen-forming bad bacteria. You can ensure that you have enough good bacteria by taking it in capsule form (widely marketed as probiotics) or naturally through fermented foods like kefir, yoghurt, tempeh, miso, and kimchi. You can read more about why it’s so important for us to maintain a healthy gut here: Keep your gut healthy – it’s your body’s second brain!.
In the same vein, calcium D-glucarate inhibits beta-glucuronidase formation in the gut. Beta-glucuronidase is a “bad enzyme” which promotes estrogen reabsorption. Calcium D-glucarate is found in fruits like oranges, apples, and grapefruit and vegetables like broccoli, cabbage, and brussel sprouts. Its also available as a supplement.
In relation to this, also avoid taking oral antibiotics on a regular basis. Antibiotics kills many types of good bacteria in the intestines and actually helps bad bacteria to thrive, which raises estrogen re-absorption in the body.
Eating more fiber also helps your body get rid of excess estrogen. Adding fiber through cereals or supplements shortens the transit time of your bowel movements. Shorter transit times means less estrogen is reabsorbed on its way out.
Comments from readers
Note: I update this list periodically, so please keep your comments coming. Thanks!
Melasma fading and “breaking up” with castor oil applications
jj c wrote, “I have been using cold pressed Castor Oil (Hexane-free) on my face every night for the last week and have noticed dramatic improvement of the texture of my skin. The melasma is starting to break up slightly and think that if I continue this regimen, that my face will be clear and beautiful by the summer. I just swipe the spots with a castor oil soaked cotton ball after I wash and can actually see some brownish stains left on the cotton ball (the hyperpigmentation of my skin?). I then coat my face lightly with castor oil right before bed each night.”
Jill wrote here (below a separate article on castor oil), “I’m on week 3 of my castor oil treatments and my face is evening out nicely. The melasma under my eyes are breaking up so much that I can see normal color skin emerging from between the slight discoloration, which by the way, used to be much darker. Strangely, my eyelashes and eyebrows look fantastic and very full. I’m sure I’ll need a couple of months altogether to start seeing dramatic improvements, but I also realize that the discoloration took some time to develop too.
On a side note, I have not had a single pimple from this treatment thus far. I usually get one or two a week. I didn’t realize this would be such a great acne prevention solution too. I use nothing else but a thin layer of Castor oil as my nighttime moisturizer. I just thought I’d point that out to anyone wishing to use this to try to treat acne.”
Melasma possibly linked to Calcium deficiency
In her search for a solution to her melasma, Sandra wrote in a comment that she believes hers was caused by a calcium deficiency. She also pointed out that the medications listed on this page can lead to calcium loss.
Sandra wrote, “Thanks for posting this website. I have melasma on my face and I have frantically been searching for a solution for years. I have to say that after all my reasearch it boils down to calcium deficieny. If you google hypocalcemia and hyperpigmentaion, you will find loads of information about photosensitive hyperpigmentation. Even the pictures of hypocalcemia patients are similar to the melasma on my face. Reasearchers are now reporting the BC pills cause women to have low calcium. All the medications you have listed on this site are hydrochloride derivatives – hydrochloride is a calcium antagonist. Just get Calcium supplements with no vitamin D (vitamin D is actually a hormone and you don’t want me to get started on that one…) Nivea has mineral oil and it should be used in the daytime because mineral oil is an excellent sunblock.”
Melasma fading with supplements
In June 2011, Maria wrote “I have been taking Coq10, milk thistle and acidophilus probiotic daily for almost a month now.
I apply apple cider vinegar and water on the dark spots every nite before i shower and I also apply enough spf 30 (uva & uvb) anti-oxidant enriched lotion twice a day.
I can sincerely say im starting to see a difference and im so happy and excited i can scream of joy.
I’ve had these marks for about 5 yrs now so i know they wont go away over night but any progress is a great feeling. I wish i had known about this before “.
In July 2011, she gave an update: “my spots look so much better & lighter… i should be happy but im not… i need to find a way to prevent them… “
In August 2010, Maria added that maca powder may have also helped. She said, “i use MACA 3 days before my period & during my whole period… then i stop & do it again 3days before my next period & so on… believe it or not… it helps me with my period, cramps & mood swings… i don’t know if this has ANY connection with my hormonal balance and my spots… i didn’t do this for my age spots but for my period…but i just thought i should put it out there…”
leili wrote that her melasma started after she took antibiotics and that she has noticed fading after taking MSM and Zinc. She also started to take extra Vitamin C and stopped eating chocolates and “noticed a big difference in two weeks”.
Melissa had fading with this regimen: “I have been taking the MSM and last week added a C, Zinc, Magnesium, A supplement plus grapefruit seed extract, and have taken Apple Cider Vinegar a couple of times and also applied it topically at night. I have to say there is definitely considerable fading plus light patches appearing in the middle of what were consistently darker patches previously !! VERY happy with the results so far, I will continue on this program and report back”
She later came back with a progress report, “Hello I am back after Christmas and New Year to report on my progress. I have changed to a Hair, skin and nails complex plus Milk Thistle (liver tonic) and Fish oil. Plus MSM when I remember but I have hardly touched it over the holidays. I have had several people say to me they notice the difference and I can see myself clearing on the cheeks and starting to get lighter patches around the hairline and more spots where the normal skin colour is coming through (yay !!). I went off my BCP 3 months ago and it was Diane Estrogen only so I was no doubt Estrogen dominant. Lost 5kg in about a fortnight too so bloating was a definite side effect. Feeling 100% better than I was, I had daily headaches to the point of migraine and living on Ibuprofen. So in summary I think getting the estrogen levels down plus getting healthy by eating really well, exercising and detoxing the liver a bit seems to be working nicely !”
Anonymous reported an 80% fading of her year-long dermal melasma with the following routine she very kindly shared. She had results in one month.
- She applied apple cider vinegar (mixed with an equal amount of water) on her face for an hour each day.
- She put on honey as a mask for an hour each day.
- When she had more time, she put on a mask of lemon and cucumber paste for an hour.
She also took these supplements.
- GSE, 100mg taken 3 times a day (I assume this is Grape Seed Extract, but could also be Grapefruit Seed Extract.)
- Vitamin C, 500mg each day
- Beta-carotenes each day
Deedub had encouraging results after just two weeks of supplementation.
Two weeks ago I started taking vitamin C, MSM, grapefruit seed extract, pycnogenol and zinc…… IT’S WORKING!!!! I would estimate that the patches (on my cheeks and forehead) are at least 50% lighter. Here’s what I’ve been taking:
3000 mg MSM – 3 x day
1000 mg vitamin C – 3 x day
50 mg pycnogenol – 2 x day
15 drops of grapefruit seed extract – 3 x day
50 mg zinc – 1 x day
Like I said, it’s only been two weeks but the initial results are really encouraging.
FreeRadical reported her melasma is disappearing as she strengthened her liver. She wrote:
I have tried both prescription and alternative treatments for my melasma. Mine was (it is currently disappearing) on my forehead, cheeks, bridge of my nose, upper lip and a little under my eyes. I didn’t find much success in hydroquinone cream 4% combined with Retin-A (although I love retin-A for different reasons). Vitamin C, taken orally and topically (in the form of active Vitamin C ester), does work a bit.
For me, the issue is liver function. The liver synthesizes hormones and cleans them from the body. My problem with melasma started after having my gallbladder removed. Most people with gallstone obstructions are overweight, estrogen-dominant women. I am not over-weight or estrogen dominant, but since the gallbladder stores bile and helps the liver supplement bile excretion, my liver function is compromised. I’ve noticed that I became intolerant to many drugs that previously were not an issue – they caused my serum bilirubin to skyrocket. Bile sequesters waste products and helps detox the body, so anytime bile flow is obstructed or reduced, there can be problems.
My cure has come as a result of addressing my liver function. I am taking Milk Thistle (Silymarin), Artichoke, Turmeric, Dandelion Root, Zinc, B6, Magnesium and Vitamin C. It is working amazingly fast and well! It sounds like a lot, but it is worth it.
Plus, my liver function is improving. I believe that melasma CAN BE a symptom of internal disease (in my case, liver problems). There’s evidence that artichoke is more effective than Milk Thistle in detoxing and protecting the liver and I added it after seeing a remarkable change from taking Milk Thistle alone. I may add Vitamin D Glucarate to see if it works but be aware that Vitamin D is a PROHORMONE (it is a precursor to hormone formation). Therefore, if you are estrogen dominant or otherwise have a hormone imbalance, proceed with caution. Of course, I’m wearing sunblock but take care to use a product that doesn’t have estrogenic effects (apparently some of the ingredients in many sunscreens mimic hormones).
One of the most effective liver supplements I’ve been taking is SAM-e. If you are on certain types of prescription drugs for depression or bipolar disorder – do NOT take SAM-e without consulting your doctor. It can be bad for your heart (it is like taking massive doses of your prescription drug – bad!) But for me, SAM-e has been great, almost miraculous, because it helps my liver and melasma but there’s no bad side effects. For those who are curious, I take Jarrow brand 200 mg extended-release tablet of SAM-e once a day. SAM-e degrades easily, so go with a reputable brand.
Anonymous said her melasma (which she has had for four years) improved 25% in about a month after taking MSM + Vitamin C + Cod Liver Oil. She said there was a definite change in the intensity of the melasma patches on her cheeks and nose.
Recommended sunscreens for melasma
Anonymous recommended a brand called TiSilc. She wrote, “A good sunscrean is TiSilc, it comes in 45 or 60 SPF (tinted or sheer/clear). It’s excellent. I have had melasma from many many years of bc and mild/mod sun exposure, before melasma was even a medical condition on the bc labels (back in the late 80s) my skin has never gotten back to the shade it was pre-bc. Tisilc will def block the sun though – use it every AM for the rest of your life.”
Laura reported that her melasma has lightened up considerably (“to a point where my tan patches are starting to look a reddish/pinkish color, and fading”) after three weeks of using Mama lotion, which is a mixture of malic and mandelic acids. She says that the product’s effects is significantly close to dermabrasion.
L had a different experience and wrote, “I tried mama lotion for 6 months, and there was some patchy improvement, but it made me peel/flaky/dry – and the melasma came back immediately when I stopped using it every other day (which I am loath to do because it is so harsh).”
Mary Locklear wrote that cleansing her system led to her melasma breaking up in some places. She wrote (excerpt): “About 2 years ago I started doing colon cleansers, and I think that that helped, because I could see breaking in some places on my face. The product is called colonix (Dr. Natura.com), and it is about $78.00 and is worth every penny. It removes yeast, poisons from your intestines, and you feel like a new person, and I noticed a little improvement in my melasma. Your organs can do their job a lot better when your intestines are cleared of years of parasites and caked on fecal matter. I will be observing my skin closely in December when I do my yearly cleanser. “
Blue Obagi peel
j75 had poor results with dermabrasion, a TCA peel and hydroquinone. She had better results with a Blue Obagi peel.
She said (excerpt): “I started seeing the large patches break up after about 2 weeks. Then I went in for my scheduled light BlueObagi peel. It starting tingling/burning a bit and she gave me a little fan to hold – then she washed it off. It really wasn’t that bad. When I left I couldn’t tell any difference. She applied a thin layer of lotion/moisturizer and gave me the tube to keep using. I used it everyday like she said so that when my skin started healing from the peel, I wouldn’t notice any redness or skin flaking. It worked. After a couple of days I even put a little foundation on. Then after a few more days, parts of the top layer of skin started coming off. The skin underneath was so smooth, tiny pores, and the brown patches of melasma were gone! I couldn’t wait for the rest of my skin to shed/heal. All of the melasma came off. It’s been several years now and the melasma that was on my forehead, upper cheeks, and nose is still gone. Now, I’ve started developing melasma on my upper lip and lower cheek/jawline. I’m planning to set up another appointment to get rid of the new melasma areas.”