Sunscreen guide for melasma patients

Sunscreens the first step in melasma treatment

If you are seeing my team & I for treatment of melasma or pigmentation, the proper use of sunscreen will give you the highest chances of pigment reduction. Without this, the chances of us improving your condition markedly diminishes. This short 3 minute read will teach you how to properly use sunscreens .

Sunscreen application; summary

• Sunscreens form the foundation of melasma management
• The most important trigger for melasma is UV radiation 
• The chances of improving melasma is ZERO if you do not get this right
• Start off with daily use of SPF 50+
• One 50 ml bottle should last you 2-3 weeks
• If you can see light, you are getting 
• Reapply in the afternoon regardless of sun exposure
• Sunscreen sprays for reapplication is better than nothing 

But I don’t go outside!

Yes you do. Unless you are incarcerated or in total isolation, you do go outside- shopping, hanging clothes, driving short distances, going to the mailbox. Get the drift?

If you can see natural light, you are getting incidental UV & visible light exposure. For the normal person, that’s fine, for the melasma patient, any amount of natural light can trigger pigment production. Forming a good sunscreen habit is essential if you want any results. 

Why should I reapply in the afternoon if I don’t go outside?

The short answer- just in case. With melasma pigmentation you can do the right thing 95% of the time, but screw up that little bit & you will undo one month of gains in as little as 5 minutes. 

Reapplication of sunscreen allows for ‘exposure mistakes’ that you will eventually make. Consider application as prophylaxis for when (not if) this occurs. You can not predict any incidental UV exposure you will make as part of your activities of daily living. For example, that unexpected or unplanned trip in the car or the brief visit outside. 

Do brands matter?

In the context of things, no, just as long as you stick to a high factor SPF 50+. The debate of what sunscreens give more UVA photoprotection or what contains nanoparticles or is good for the environment is irrelevant in the big picture of melasma & pigmentation management. It is the quantity & frequency of application that matters most. 

Once you get this right (90% of patients take at least 6-12 months to get their sunscreen habits down pat), you can then concentrate on the finer points of sunscreen. Don’t miss the forest for the trees. 

Do I encourage aerosol sunscreens for melasma – are they any good?

The aerosol sunscreen debate is that they are not as good or as effective as sunscreen lotions. There are several sides to this argument, but in the context of managing melasma & pigmentation, I am in favor of aerosol sunscreen simply because they are convenient. I am far happier if you have some sort of UV protection in the afternoon as compared to nothing at all because of the inconvenience of reapplication, especially at work.  

Note: aerosols should not replace sunscreen lotions especially if you are engaging in sporting activities or sweat in summer. 

What are my recommendations?

I’m super happy if you just use sunscreens correctly, brands don’t matter, however here are my recommendations-

Daily: La Roche Posay, Invisible Zinc, Melan 130

Sport / waterproof: Neutrogena Sport, Cancer Council, Sunsense, Banana Boat

Sprays/Aerosols: Neutrogena, Avene  

More on how to integrate sunscreens with your melasma skin care.

What is iron oxide & why is it good?

Iron oxide attenuates blue & high energy visible light, this wavelength can make melasma worse (that is why you should avoid LED masks). 

Iron oxide is found in some sunscreen products such as Melan 130, but it is difficult to find an exact color match for your skin, hence why you should augment your sunscreen with mineral makeup (contains iron oxide). This 1.) protects you against visible light 2.) ensures you don’t look silly with a wrong color match 3.) covers up melasma pigmentation. 

What is the skin science behind sunscreens?

The fundamental cornerstone of any skincare regimen revolves around the use of sunscreens. More than 90% of skin aging, referred to as photoaging, is attributed to UV rays. This is particularly significant in Queensland, Australia. UV exposure not only leads to cosmetic concerns such as melasma, pigmentation, and wrinkles but also increases the risk of skin cancer. It’s a fact that two out of every three Australians will develop either sunspots or skin cancer by the age of 55. With numerous brands and formulations available, determining the best sunscreens for your needs can be confusing. This page aims to provide you with a guide on everything you need to know to find the optimal SPF, following the recommendations of Davin Lim.

*What do I know about sunscreens? I spent my registrar training in the subspecialty of photobiology & photodermatology in the UK, Scotland & Ireland. I have authored a few papers on sunscreens & have been fortunate enough to have had clinical training by world renowned bosses in these countries. Blessed!

What’s the difference between mineral & chemical sunscreens?

Mineral and chemical sunscreens are both effective at protecting you from ultraviolet radiation, however they work in different ways. 

Mineral sunscreens, comprised of ingredients like zinc oxide, titanium dioxide, and iron oxides (unavailable in Australia but obtainable abroad), were traditionally believed to primarily reflect UV radiation. However, recent studies indicate that they, like chemical sunscreens, absorb and transform UV radiation into heat. Chemical sunscreens, containing substances such as avobenzone, oxybenzone, and octinoxate, operate similarly by converting UV radiation into heat, posing minimal harm to the deeper layers of the skin.

Hybrid sunscreens, incorporating both physical and chemical blockers, are prevalent in contemporary formulations. Many dermatologists recommend these hybrids, particularly for individuals with highly sensitive skin conditions like rosacea, dermatitis, or eczema. In contrast, those with extreme sensitivity may opt for 100% physical blockers, such as Invisible Zinc. Chemical sunscreens may lead to more irritation, though allergic and photoallergic reactions are exceedingly rare. For those experiencing such reactions, medical dermatologists may conduct patch and photopatch testing, with avobenzone being an uncommon allergen.

While the majority of sunscreens in the market today are hybrid formulations, it is crucial to emphasize proper usage rather than fixating on specific brands. As highlighted on this website and various social media posts, cultivating the habit of using sunscreens correctly takes precedence over intricate product details.

What is the best sunscreen?

The most effective sunscreen is one that you consistently apply every day, ideally twice a day. My top three recommendations are Melan 130 (pricey but excellent), La Roche Posay Anthelios (lightweight and budget-friendly), and Invisible Zinc (cost-effective with high protection). Keep in mind that the feel of a sunscreen is subjective.

When selecting the right formulation for your skin type, consider the following checklist:

1. Daily Use: Apply sunscreen daily, as you are still exposed to UV rays even on cloudy days. Establish a habit to ensure you are always protected, regardless of weather changes. Find a daily face sunscreen that suits your needs, not just one for beach trips.

2. Two Types of Sunscreen: Have a daily sunscreen (as mentioned above) and another for outdoor activities, especially those involving water. The “active” sunscreen should be waterproof and last at least 2, preferably 4 hours. Ego Sport or Neutrogena offer effective options.

3. Reapplication: Applying sunscreen once in the morning may not be sufficient, especially if you’re outdoors for an extended period. Reapply around midday or before your daily commute home. Even if you’re indoors all day after the morning application, plan to reapply at some point.

4. Price Point: Focus on the feel, not just the cost. Expensive doesn’t necessarily mean better. In the case of sunscreens, pricier products often require less application, so choose a sunscreen that fits your budget.

5. Skin of Color: Regardless of whether you burn or not, sunscreen is crucial for protecting your dermis and collagen. A high SPF can prevent pigmentation changes like melasma and post-inflammatory hyperpigmentation.

6. Tinting is essential: If you suffer from melasma or post inflammatory hyperpigmentation, a tint is essential as tinting blocks out HEV or blue light. Blue light lies in the visible spectrum & activates pigment cells that contributes to melasma pigmentation. Iron oxides are responsible for the colour in tinted sunscreens.

In conclusion, there is a wide variety of sunscreens, and their effectiveness can vary from person to person. If you don’t like one, don’t be discouraged; keep trying. Adopting a “try before you buy” approach is not just an Asian mentality; it should be applied to your sunscreen purchases to find the one that suits you best.

Sunscreens should be combined with specific pigment correctors to treat melasma.

What is the correct amount of sunscreen to apply?

It’s a fact: 95% of individuals use insufficient sunscreen. Did you know that the SPF rating isn’t solely determined by the sunscreen’s ingredients but is heavily influenced by the quantity applied? SPF is, in part, determined by applying 2mg per cm2 of product. This translates to approximately 3.5 to 4.5 ml to cover the head and neck. Reducing this amount by half effectively reduces the SPF by half. Therefore, before delving into concerns about ingredients, UVA versus UVB protection, photo allergies, and intricate details, prioritize the correct application quantity and frequency. Follow my ‘2’ rule for sunscreen: ‘two fingers of sunscreen, twice a day, two types.’

How many times do I need to apply sunscreen per day?

In reality, it varies. If you don’t have specific skincare objectives and work indoors, applying sunscreen once a day is likely acceptable. This stance contrasts with the advice of many dermatologists who advocate for reapplication every 4 hours (some even recommend every 2 hours). Let’s consider the numbers: the correct application amount is an average of 3.5 ml for the face, neck, and decolletage. If you apply three times a day, that totals 10 ml per day. A standard sunscreen bottle is typically 50 ml, meaning you would go through 6 bottles in a month. It’s unlikely that any sensible dermatologist would endorse such a high sunscreen usage. The same analogy applies to dentists—while the recommendation is to brush after every meal, would most dentists actually brush that frequently?

However, if you are addressing a specific skin issue or concern, it’s a different story. For conditions like melasma or similar pigmentation problems, applying sunscreen at least twice a day is non-negotiable.

How do I layer sunscreen and moisturizer?

If you’re using sunscreen in the form of a lotion or cream, which is the case for most formulations, it’s advisable to apply it after your moisturizer. Combining it with your moisturizer results in the dilution of the sunscreen and diminishes its protective efficacy. To gauge the SPF protection accurately when diluting sunscreen, consider this: if you use half the recommended amount or mix it with moisturizer, you effectively halve the SPF. For instance, if your sunscreen is SPF 30+, diluting it by approximately fifty percent in moisturizer reduces the effective SPF to 15. Therefore, it’s crucial not to dilute your sunscreen.

What’s the difference between SPF30 and SPF50+?

An SPF 30 permits around 3 percent of UVB rays to reach your skin, while an SPF 50 permits approximately 2 percent of those rays to penetrate. While this difference may appear minor, it becomes significant when you recognize that SPF 30 allows 50 percent more UV radiation onto your skin. Hence, opting for a higher SPF is preferable, as explained below.

Do skin care actives designed to treat melasma interact with sunscreens?

No. A simple, yet effective skincare routine that targets pigment is –

Vitamin C in the morning (serum 15%, L-ascorbic acid), followed by sunscreen.

What does the SPF rating on sunscreen mean?

The SPF number indicates the time it would take for the sun’s UVB radiation to cause redness on your skin, known as the minimal erythema dose (MED). Therefore, with SPF 50, it would ideally take fifty times longer to experience sunburn compared to not wearing sunscreen.

In specific terms, SPF 30 allows approximately 3 percent of UVB rays to reach your skin, while SPF 50 allows about 2 percent. Although this may initially appear to be a minor distinction, the significance becomes apparent when you realize that SPF 30 permits 50 percent more UV radiation onto your skin. This difference is accentuated by the fact that SPF is tested in controlled laboratory conditions using a specified amount of sunscreen (applied generously). Halving the amount of sunscreen effectively halves the SPF. Hence, opting for a higher SPF is recommended to compensate for the application amount. While choosing a minimum of SPF 30 is advisable, SPF 50 is even more preferable.

What is the most effective sunscreen type: lotion, cream, or spray?

Lotions and creams are recommended by dermatologists as they offer a lighter feel. Sunscreen sprays are generally not recommended due to the challenge of achieving a thick enough application for the advertised SPF. Exceptions may apply, such as difficulty in self-applying sunscreen to the back where a spray formulation can be sensible.

Do I need to wear sunscreen indoors?

The answer depends on the context. For radiation from computer screens and devices, the answer is generally no. However, when it comes to UV exposure from sitting next to a window, it depends on the type of glass. Window glass protects against UVB, but UVA penetration varies. If unsure about the glass type, wearing sunscreen is advisable, especially for those with melasma pigmentation.

How long does sunscreen remain effective after application?

A sunscreen’s SPF is fully effective for two hours after application, influenced by factors like formulation and activity level. While some suggest reapplying every two hours, practicality should be considered, especially in regions with prolonged sunlight. Deciding whether to reapply multiple times a day depends on personal habits and practicality.

Can vitamin D levels be too low with sunscreen?

The primary source of vitamin D is UVB radiation from the sun, and exposure levels vary based on location, time of year, time of day, and cloud cover. While regular incidental sun exposure typically maintains adequate vitamin D levels, those vigilant with sun protection may have lower levels. In such cases, taking a vitamin D supplement is a simple solution, akin to other commonly taken supplements for various health benefits.

How does the Melasma Clinic treat melasma?

Now that you know how to effectively employ sunscreen into your skincare routine, let’s focus on the actual treatment of melasma. This is how we do it at The Melasma Clinic. 

1. Pigment corrector: prescription pigment correctors include arbutin, ascorbic acid, kojic acid, cysteamine, tretinoin & hydroquinone. The exact formulation depends on your pigment type, depth & skin sensitivities.
2. Laser or chemical peel program. The clinic has various lasers & peels to help address melasma pigmentation. They include pico lasers, Cosmelan & Dermamelan peels, glycolic & lactic acid peels as well as fractional lasers.
3. Supplements & vitamins: Antioxidants are useful adjunct to the above treatments. We use both polypodium extract as well as glutathione supplementation to help reduce oxidative stress & pigment production. They can be marginally effective as stand alone treatments, hence they are best integrated with our pigment treatment programs.