You Say "Miasma," I Say Melasma

a skin condition that can feel like harassment

Welcome readers, old and new!

Before we get into today’s nitty-gritty, a brief but delectable description (sent to me by a friend) of a $$$ facial cream.

Introducing [said facial cream]—infused with rare Moonlight Flower, an elusive plant that blooms one night a year, and only for a few hours. Hand-picked at its peak potency and immediately flash frozen to harness a precious anti-aging cryoextract with rare results. Skin appears 5 years younger after 3 months. Discover [it] exclusively at [department store/Garden of the Hesperides].

Who wrote that? I’ll have what they’re having!

Please tap the ❤️ above to send a bucket of hand-picked Moonlight Flowers to inventive beauty copywriters everywhere.

Keeping with our theme of the power of language, let’s start with a Word of the Day: miasma. Why miasma? (We’ll get to the beauty connection in a minute.) You might associate miasma, as I do, with a simpler word—like, say, stink. The noxious gases arising from a toxic waste dump, for example, or a certain kind of politician. But miasma is from the Greek, literally meaning defilement. As in the violation of a woman. A woman such as the venerable advice columnist E. Jean Carroll. As I write this, E. Jean is on the stand in a courtroom in New York City, testifying that first her body was defiled and then her character by a certain politician.

We don’t yet know the outcome of E. Jean’s trial—but by stepping forward, she’s courageously aiming to clear the air of one persistent miasma that’s been choking an astonishing number of women for years. 🙏 E. Jean, 🙏

I am reminded of a magazine story I read years ago in which the writer, reporting on the sexual harassment of women, mentioned that when she began to ask her friends if they had ever been sexually harassed, she was amazed when every single one of them told her, “Yes.” Digesting that information I thought how lucky (and unusual) it was that I had never been exposed to that kind of harassment. Uh, wait…

Except: Walking the short distance from my magazine office to a deli to pick up a sandwich for lunch, I was punched hard in the crotch by a passing businessman.

Except: Driving on a New Jersey highway with my sister to visit our father, recovering from heart surgery in a New York City hospital, we turned to see, in a car parallel to ours, a man masturbating in the driver’s side window.

Except: Hurrying to my job on a beautiful spring morning, I ducked into a coffee shop and begged the owner to help me escape a man who refused to stop following me; the owner got rid of him by telling him I was his wife.

When harassment is all around you, it can feel invisible. A fact of life. But it is not.

Which brings me, finally, to a frustrated reader, who asks about a condition she mistakenly refers to as her “miasma mustache.” It’s actually a melasma mustache, but it can feel as intractable as an unwanted advance. 

Q: My miasma mustache. Why, god, why?!?! What do I do?

A: I feel your pain. As for the whys and wherefores of your problem, I turned, as usual, to HNTFUYF DermDiva, Heidi Waldorf.

First, the less-good news. “Melasma is much harder to improve than standard hyperpigmentation from photodamage,” said Waldorf. “It’s triggered by a combination of ultraviolet exposure, estrogen, and inflammation in someone who happens to be genetically predisposed.” Unfortunately, we don’t know what makes someone predisposed. Continuing in the unfortunate vein, there isn’t an easy fix with topicals or devices, said Waldorf. Over-the-counter topicals have limited effect on melasma and are best used as adjuncts, in addition to prescription treatment. 

What’s the prescriptive? “The classic treatment for melasma is a topical cream composed of retinoic acid, hydroquinone, and a corticosteroid,” said Waldorf. You can get the cream as a pre-prepared branded prescription or as a customized mix made by a compounding pharmacy as ordered by your dermatologist (which is usually much less expensive than the branded version). 

How does the cream work? Retinoic acid, the active retinoid in tretinoin, aids in cell turnover and works directly on pigmentation, said Waldorf. Hydroquinone “turns off” the enzyme that produces pigment. And corticosteroids reduce inflammation caused by the retinoic acid and hydroquinone, thus limiting the inflammatory aspect of melasma. 

While over-the-counter hydroquinone is available up to 2%, prescriptions generally use concentrations from 4–10%. (Waldorf usually uses 6%.) Retinoic acid is typically prescribed at 0.025%, 0.05%, or 0.1%. The corticosteroid is used in a mild to mid potency, said Waldorf. 

Though vitamin C, polyphenols, cysteamine, and tranexamic acid are some of the ingredients commonly shown to help reduce pigmentation, they’re less well studied for their effects on melasma. For the most resistant and extensive cases, Waldorf said that oral tranexamic acid prescribed off-label is effective. But because its primary use is to promote clotting to treat uterine bleeding, a thorough review of your medical history is critical before it’s prescribed. 

Although treating pigmentation from photodamage is straightforward with lasers and other energy-based devices, there’s a significant risk of triggering increased pigmentation when using any heat-based device with melasma, Waldorf warned. The MOST important strategy to prevent melasma is ultraviolet protection—in other words, sunscreen. She recommends a high concentration physical sunblock, a brimmed hat (I love these and bought one in Tokyo) and/or face shield, and limited outdoor exposure during peak sun time.

Serendipitously, I recently received a few emails about hyperpigmentation—a.k.a. the spots on your face from photodamage. As Waldorf notes above, photodamage is different from melasma and somewhat easier to treat. I wrote about hyperpigmentation and how to diminish it here. Bottom-line: You don’t have to live with hyperpigmentation or melasma, no matter how spotty your past.

A Moment of Personal Horn-Blowing

HNTFUYF was recently included in a roundup of the “23 Best Health and Wellness Newsletters of 2023” by the (what else?) health and wellness website Ness. Thanks, Ness, and thanks to all you HNTFUYF-ers for inspiring me with your thoughtful questions and comments. xo

Serious about selling you kinder self-regard.

HNTFUYF, a Payola-Free Zone

Readers, a few of you have asked if I get a cut from sales when I mention a product. I do not. I only mention products I’d like to buy myself, and therefore think you might like, too. I share this so you know my recommendations are offered without obligation.

Val Asks You

Don’t be shy! What’s your most vexing or intractable appearance issue? Send your beauty-related questions to valeriemonroe@substack.com. If I don’t have a good answer, I’ll find someone who does.