Talking Melasma with LaLa Romero and Hong T. Nguyen, MD

Melasma is a common skin problem that causes brown to gray-brown patches, usually on the face. Most people will see it on their cheeks, the bridge of their nose, forehead, chin and above the upper lip. It can appear on other parts of the body that are exposed to a larger amount of sun, such as the forearms and neck.

Melasma is most common in women age 20-55, often appearing during pregnancy, but it also affects people living in sunny climates and people with darker skin pigmentation. This condition can be challenging to manage because sun exposure triggers symptoms.

We sat down with two experts to help you better understand the condition. First, we chatted with LaLa Romero, music artist and Apple Music DJ who was diagnosed with melasma

How long have you had melasma?

I remember noticing a weird discoloration on my upper lip, like a shadow about twelve years ago, but my mom thought I was overreacting. Things then got progressively worse over the next year, and it's been a battle ever since.

Because melasma is sometimes hereditary, do other people in your family suffer from it, and did you know what it was and what to expect?

No one in my immediate family had it when I first got it. My family is Mexican American, Navajo and Apache, and I didn't grow up wearing or even having sunscreen in the house. That's an important conversation in itself; brown people need to practice sun care. My family was oblivious and I am the fairest in my family so they just thought it was like a patchy tan or something that would even out one day.

You’re vocal about your condition. What made you want to spread the word?

Honestly, my case isn't very severe but just seeing how frustrating treatment has been for me made me want to encourage more dialogue. It's hard to get a straight, concise answer on how to battle it, and the condition always comes back. I've also wasted a lot of money trying to combat it - trying anything and everything. I hope this dialogue will help other women know they aren't alone, while giving them some useful insights from my experience.

What kind of treatments have you tried for your condition and what has worked the best?

I have tried every fading cream - from things at the drug store to custom compounds recommended by my dermatologist. The most heartbreaking part of this condition has been having to stay out of the sun. I love the ocean and swimming in it. That has been really hard because I have to stay completely out of the sun to keep the melasma at bay. My dermatologist also suggested I stop doing hot yoga because the heat seems to trigger the melasma. It's very frustrating.

Why is having a strong relationship with your dermatologist important?

Since my melasma is a constant battle, seeing my dermatologist regularly is the only way I can keep it in check. It recently got bad again, and I thought it might be hormones or that I was doing hot yoga. Once I talked to my dermatologist, I quit the yoga per her advice and it's in check again.

Did you have any issues with being a public figure, especially in music and entertainment with your condition?

I have been privileged to have a great doctor and to have access to products and care that have kept my melasma from getting too severe. It's expensive, though, and it took a lot of trial and error. So far, makeup keeps it concealed for me. I know that's not the case for everyone, and I know it may not be the case in the future.

Many people with melasma are more prone to social anxiety. Does your condition make you anxious?

I have struggled with social anxiety my whole life, that's for another blog post, though! On a serious note, melasma hasn't helped with my anxiety; it's just another crappy thing that makes you self-conscious. My heart goes out to other women who suffer from it and haven't found the right treatment or can't afford it. I also think that because some people consider it a "cosmetic thing," other people can sometimes be very dismissive about it, which is really hurtful for women struggling with it. It's your face, and it becomes big, weird patches that legitimately look like dirt - it makes you anxious and self-conscious.

What advice would you give young women living with melasma?

I’d tell people to realize that they will have to make some lifestyle adjustments. To know that it's not fun and it's not fair and that you have to wear sunscreen daily and stay out of the sun. Don't waste your money like I did on a bunch of over-the-counter products. If you can afford it, go see a dermatologist when the first patch pops up. It’s really important that brown and black girls also wear sunscreen - we are not exempt - in fact, some say we may be more at risk. But most importantly, I would tell them to know that you aren't alone. Once I started to talk about this with my girlfriends, I began to realize it is way more common than I thought! It may not go away completely, but it is treatable!

Next, we chatted with Dr. Hong T. Nguyen, a dermatologist at Mission Heritage Medical Group. We asked Dr. Nguyen to explain the symptoms, causes and treatment for melasma.

What is melasma?

Melasma is a skin condition that causes discoloration that looks like brown spots or patches. We haven’t fully determined how it’s caused, but we believe it results from overproduction of pigment on the skin, usually triggered by hormonal changes or time in the sun. Melasma primarily appears on the face (nose, cheekbones, and jaw) but can occur on other parts of the body too.

How common is melasma? Who is most likely to get melasma?

Although it can affect everyone, melasma is particularly common in women, especially pregnant women and those with darker skin. About 90% of people who develop melasma are women and about 6 million women in the United States are estimated to cope with the condition.

What is the primary cause or risk factors?

Again, we’re not entirely sure what causes melasma, but we do know that sun exposure, hormone sensitivity, and darker skin types are associated with it. Often, we see melasma triggered by birth control pills, pregnancy, and hormone therapy. Some researchers have even suggested that stress and thyroid disorders might be at the root of the condition.

I always advise my patients who experience melasma to stay out of the sun and wear sunscreen daily – ultraviolet rays can cause the cells that control pigment production (melanocytes) to go into overdrive, leading to the increased levels of pigment that create this discoloration.

When does it present?

Melasma’s symptoms often present gradually over time, but can also develop with certain occurrences like pregnancy, new birth control pills or hormone treatment.

How is it diagnosed?

Usually, the condition can be diagnosed visually by your doctor or with a Wood’s lamp examination. This special device allows a doctor to check for infections and determine the severity of the melasma. In rare cases, your doctor might also conduct a biopsy to check for any serious skin conditions.

What are the symptoms?

Melasma’s symptoms are patches of discoloration darker than an individual’s typical skin color. Most of the time, these spots occur on the face and are symmetrical in shape, with matching patches on both sides.

The condition won’t cause any physical harm, but it can have an emotional impact. Some patients are self-conscious about the way their skin looks.

Is it treatable?

In some cases, melasma will go away on its own, mainly when caused by pregnancy or birth control pills. Unfortunately, though, some people will experience melasma for years at a time or even throughout their life. The good news though is that there are treatments available, as well as steps one can take to mitigate the impact of the condition.

What are the treatments?

The most common treatments for melasma are topical brightening creams and steroids that can lighten the affected areas. Sometimes, chemical peels, dermabrasion and microdermabrasion can help more stubborn cases by removing the outer layers of skin.

Such efforts don’t always guarantee that the condition won’t return, but I’ve found that the majority of my patients have been able to cope with the condition by using makeup to cover spots, wearing sunscreen every day, and using hats to shade the face when outside.

Is each case different?

Yes—each case is different. Sometimes patients struggle with the condition for years at a time; some experience it only for a short while. The levels of discoloration can vary greatly too and can often change throughout a patient’s life.

Is it preventable?

In some cases, melasma might not be preventable but there are steps one can take to reduce its impact like avoiding the sun, wearing hats and sunscreen or switching birth control pills.

Why is it important to have a good doctor-patient relationship?

Though melasma won’t cause any physical effects beyond discoloration, the condition can be stubborn and difficult to treat. When a dermatologist has a good relationship with a patient, treating the condition will be easier as the doctor will better understand a patient’s medical history and lifestyle, and the treatment options that will work best for a patient’s particular needs.

Additionally, a dermatologist will have access to resources such as support groups or information materials that can help a patient better manage the condition.

To learn more about skin conditions, check out some of these articles

Living with Eczema: Love the Skin You're In »
Talking Psoriasis with Caridee English and Dr. Kassabian »
Quiz: Know the Skin You're In »
Is inflammation related to chronic disease? »

Providence St. Joseph would like to thank LaLa for being a paid partner with us on this important topic.

Providence is pleased to share the stories of great people who have overcome health conditions. As part of our population health program, we want to share insights and stories that help bring awareness to common health conditions. Not all the people featured in our stories are Providence patients.