Posted on April 15 2015
Melasma and Melasma Treatment
Melasma is a common cause of pigmentation and can be caused by genetic, hormonal and UV factors. Melasma is one of the most resistant skin conditions to treat and can take time and persistence. With the use of prescription creams, peels and the latest in laser treatments, up to 80% of melasma conditions will improve. The condition can be recurrent, and having both a treatment and prevention program (along with finding out the cause) is the foundation to achieving results that is long lasting.
Melasma is a form of blotchy, brownish facial pigmentation affecting the forehead, cheeks and commonly the upper lip areas It tends to affect darker skin type and it can lead to considerable embarrassment and distress.
. Genetic- not everyone will have a family history of melasma, however some people are pre-disposed to this condition. Melasma is more common in females of darker skin races, such as Asian, Mediterranean or Middle Eastern (one third of patients have reported other family members have been affected)
. Hormonal - oestrogen from the birth pill, or pregnancy can activate the pigment producing cells in the skin which results in excessive pigmentation. In many situations, despite having no history of pregnancy or the pill, some people have melanocytes that are sensitive to normal amounts of hormones. In others it may occur in pregnancy- which often fades several months after giving birth. Hormone replacement and implants can also be cause.
. UV exposure (sunlight) – Even brief exposure to UV light can stimulate pigmentation. The use of sunscreen 30+ is imperative in treating melasma.
Medications, scented or deodorant soaps and cosmetics can cause a phototoxic reaction that triggers Melasma.
In the majority of cases IPL can and often will worsen melasma. This is due to the excessive heat generated by IPL. This in turn stimulates the pigment cells to produce even MORE PIGMENT. Most patients will notice some lightening, then melasma rebounds with intensity following IPL, especially if prescription creams are not used prior, during and after the procedure.
(a combination of the following is recommended for optimum results)
. Discontinue hormonal contraception.
. Year-round life-long sun protection. Use broad-spectrum very high protection factor (SPF 30- 50+) sunscreen applied to the whole face every day. It should be reapplied every 2 hours if outdoors during the summer months. Alternatively or as well, use a make-up that contains sunscreen. Wear a broad-brimmed hat.
. Use a mild cleanser, and if the skin is dry, a light moisturiser.
. Regular exfoliation (twice a week) to remove dead skin cells on the surface of the skin to ensure topical products can penetrate the skin properly and not sit on the skins surface)
. Cosmetic camouflage (make-up) is invaluable to disguise the pigment.
Tyrosinase inhibitors will lighten the pigment issues. The treatment aim is to prevent new pigment formation by inhibiting formation of melanin by the melanocytes.
▪ Kojic acid is often included in formulations, as it binds copper, required by L-DOPA (a co-factor of tyrosinase).
(Our Biowhite Serum for pigmentation and TCA, Lactic and Glycolic Peels are successfully in Melasma treatment)
▪ Hydroquinone 2–4% as cream or lotion, applied accurately to pigmented areas at night for 2–4 months. This may cause contact dermatitis (stinging and redness) in 25% of patients. It should not be used in higher concentration or for prolonged periods as it has been associated with ochronosis (a bluish grey discolouration).
▪ Azelaic acid cream or lotion.
▪ Ascorbic acid (vitamin C) also acts through copper to inhibit pigment production. It is well tolerated and is usually combined with other agents.
▪ Topical alpha hydroxy acids including glycolic acid and lactic acid, as creams or as repeated superficial chemical peels, remove the surface skin and their low pH inhibits the activity of tyrosinase.
▪ Topical retinoids, such as tretinoin (a prescription medicine) are effective. Tretinoin can be hard to tolerate and sometimes causes contact dermatitis. Do not use during pregnancy.
▪ Salicylic acid, a common peeling ingredient in skin creams, can also be used for chemical peels but it is not as effective for Melasma Treatment as Lactic and Glycolic.