MELASMA

Melasma is a skin condition is characterised by blotchy pigmentation occurring in a somewhat symmetrical fashion on the face. Common areas include the forehead, upper lip and upper cheeks. It is primarily found in adult women between the ages of 20 and 40 but can affect men as well. Melasma often darkens in summer and lightens in the winter. It can be very upsetting and unpleasant for those who suffer from it.

Melasma is caused mainly by hormonal factors, frequently onset by pregnancy, the contraceptive pill or those with polycystic ovaries (PCOS). It is further enhanced by sun exposure.

Melasma can affect self confidence and be debilitating for some.

SYMPTOMS

Melasma is characterised by patches of lighter or darker brown pigmentation, usually to their cheeks, forehead and upper lips. It has been referred to as the mask of pregnancy.

It is generally classified according to where the pigment is located in this skin; more superficially in the epidermis, deeper in the dermis, or a combination of both. Those with deeper dermal pigmentation are much more difficult to treat.

CAUSES

Melasma occurs due to excessive stimulation of melanocytes which produce excess amounts of melanin (brown colour). The known causes are:

  • Sex - Melasma is more common in women, primarily between the ages of 20 and 40.
  • Hormones - Melasma often peaks during pregnancy and is often due to hormonal imbalances such as Polycystic Ovaries and those who take medications containing oestrogen such as the combined contraceptive pill (oestrogen stimulates the production of melanin.
  • Genetics - there is a known genetic link.
  • Skin type - the condition is often worse in darker skin types such as those of middle eastern, Indian and Asian descent.
  • Sun exposure - melasma is triggered and made worse by exposure to UV light.

TREATMENT

Melasma is a chronic condition and many of those who suffer from it feel they have tried 'everything’. There is no real cure and treatment is aimed to control the condition, suppress the pigmentation and reduce the appearance of hyperpigmentation. The treatment is known to relapse, especially if the triggers are not treated (such as sun exposure).

Those with superficial melasma (pigment in the epidermis) are more likely to respond to treatment and the earlier treatment is initiated the better as this can delay the onset of deeper pigmentation which is more difficult to treat.

Individual patient factors must be considered including patient objectives, risk of downtime and severity of the condition. It is important to treat Melasma carefully and effectively as disturbing the basal layer of the skin can risk further pigmentation. Pigment will return with continued UV exposure.

There are stages for treatment;

  1. Remove exposure to triggers - Strict sun protection and daily use of a broad spectrum SPF is essential.  Any sun exposure will trigger and stimulate the melanocytes and exacerbate the condition. Consider discontinuing use of hormonal treatments such as the contraceptive pill and treat any underlying hormonal problems such as PCOS.

  2. Topical treatment – aim to slow down melanin production and reduce the appearance of pigment. These include prescribed creams as well as cosmeceutical brightening and lightening creams containing ingredients such as retinol and kojic and azelaic acid.

  3. Chemical peels - For melasma unresponsive to topical treatments and to combine treatments for maximal results chemical peels are a safe and effective option. Chemical peels cause exfoliation of the superficial to mid layers of the skin. This treatment is most effective for epidermal melasma.  The most commonly used peels are glycolic acid, salicylic acid, mandelic acid and citric acid. Combination TCA and Jessners peels can also be used.

  4. Laser and BBL - Laser is reserved for severe cases and when used incorrectly and without adequate skin preparation (such as use of a topical melasma treatment) can make melasma significantly worse. Results from laser and light based treatments (such as BBL and IPL) is unpredictable and associated with more adverse effects. It is best used in cases of superficial melasma where the pigment sits in the top layers of skin rather than deep pigmentation. Different lasers may also need to be used to target pigmentation at different levels.

  5. Dermamelan  - Dermamelan is the gold standard topical treatment for melasma and pigmentation. It is a mask application containing active ingredients which work to suppress melanin production, reduce the appearance of melanin and prevent recurrence of pigmentation. It is safe on all skin types including darker skins which cannot be treated safely with other methods.  Dermamelan is a new and safer alternative to other treatment modalities and can be used effectively in ALL skin types.

Regardless of the treatment regime it is important to note that ongoing treatments may be needed and continuous home care and sun avoidance is essential to suppress the pigmentation. Treatments are aimed to maintain and control the condition.