When temperatures rises during warmer months, it can be increasingly difficult to deal with a melasma mustache. While packing on the foundation and concealer can be a simple quick fix, experts says it takes time, patience and consistency to say goodbye to the dark, hard-to-miss shadow above the upper lip.
What Triggers Melasma
According to Bloomingfield Hills, MI dermatologist Linda C. Honet, MD, melasma is caused by a combination of hormones and genetics and is triggered by sunlight. “The challenge is that melasma is a complex, multifactorial condition and there may be underlying factors that we have yet to elucidate and understand. Underlying the pigmentation is a fine vascular network that may in fact ‘feed’ and support the pigment network and may have a more significant role than we know.”
“Genetics alone can cause an increase of melanin production, but it can also be caused by pregnancy, sun exposure, hormone fluctuations, and certain medications including oral contraceptives or photosensitizing medications,” adds Chico, CA dermatologist Kafele T. Hodari, MD. “This particular set of circumstances results in what is called melasma. It can even result from inflammation and irritation from acne.”
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“No matter what the treatment is, adequate amounts of sunscreen must be used at least 30 minutes prior to sun exposure and reapplied every two hours,” says Saddle Brook, NJ dermatologist Dr. Fredric Haberman.
“It can be a beast to treat, so hats, sunglasses and sunscreen are a must to prevent—especially if you are on hormones,” adds Prospect, KY dermatologist Tami Buss Cassis, MD.
Oral + Topical Remedies
Fort Lauderdale, FL dermatologist Dr. Matthew Elias says sunscreen and hydroquinone are still the gold standard for treatment. “Sometimes we also have to have old school Tri-Luma topical cream compounded with 6 or 8 percent hydroquinone and have patients jump-start treatment with that for two months.”
“For a melasma mustache, I recommend beginning treatment with Retin-A co-inventor Dr. Albert Kligman’s original compound which includes hydroquinone, Retin-A and triamcinolone, which is referred to as ‘triple bleaching cream.’ Since melasma mustaches can be difficult to treat, remember that patience is a virtue,” adds Dr. Elias.
“Sunscreen and sun protection,” says New York dermatologist Doris Day, MD. “I also like Heliocare Dietary Supplement ($30) to enhance UV protection or ISDN’s SUNISDIN Softgel Capsules ($50). Also try to avoid birth control or any hormonal therapy. For skin care, I recommend Even Tone Correcting Serum ($140) by Skinbetter Science twice daily and hydroquinone 4 percent on top of it at night, or if you’re pregnant, Glytone Brightening Complex ($74).”
Pral antioxidant supplements like the fern extract polypodium or a topical milk thistle derivative called silymarin may be helpful, too. “Since hyperpigmentation is related to UV exposure, whether it is photoaging or melasma, the oral supplement Heliocare ($30) may be useful,” says New York dermatologist Heidi Waldorf, MD. “Heliocare’s proprietary ingredient is an antioxidant derived from the Polypodium leucotomos fern that’s been shown in clinical studies to reduce the inflammation and free radical formation specifically caused by ultraviolet exposure. It is not a substitute for sunscreen and sun protective hats and clothing. It is an additional way to protect at-risk skin.”
Dr. Honet says Cyspera, a topical cream, is also effective for those who want to treat the issue from home. “Cyspera touts an amino acid analog, cysteamine, for short-contact therapy to treat pigment and melasma,” she adds.
“Topical cysteamine cream is an excellent solution and the formula has come a long way,” says Delray Beach, FL dermatologist Dr. Janet Allenby. “When it first came out a few years ago it had a very strong smell that sort of followed you after you washed it off, however, they’ve perfected the formula and it’s now a three-part system that is much more tolerable in terms of smell and irritation for those with sensitive skin. It’s safer than hydroquinone and the new formula is much more sophisticated so you don’t have to worry about an unpleasant smell or compliance for the recommended 12 weeks. Patients are more likely to stick with it as the system—which includes a neutralizer to wash it off and a boosting serum—makeing the 15-minute process easier to follow.”
As far as zapping the melasma with a laser, that part is tricky. The dermatologists we spoke to all said chemical peels are the go-to in-office treatment, but certain lasers can also help minimize or eliminate the mustache. But many lasers can make melasma worse, so it’s important to go to a board-certified doctor who can guide you to the right procedure. “I like to do chemical peels, like the VI peel, and alternate with the PicoWay laser,” says Dr. Day.
“Excellent results can be seen for melasma by combining a thulium laser, like Fraxel or Permea, and a Pico laser like the PICO Genesis FX,” adds Dr. Elias.
Dr. Haberman notes that a laser treatment may not be the first option he would choose for treatment and advises sticking to topical solutions. “I would avoid Fraxel, Permea and Pico laser as early treatments and be very patient while treating this problem,” he advises. “If after at least 60 days the response to treatment is poor, I would perhaps change to a double bleaching preparation containing 1 percent kojic and azelaic acids, which can also be compounded with 5 percent niacinamide.”
The Bottom Line
No matter the treatment approach, there are viable options out there to correct melasma. If there is one thing all of the skin-care experts we spoke to stressed, it was that melasma is extremely hard to beat without consistency and dedication to a treatment plan and a commitment to avoiding the sun.
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