Melasma: Causes and Treatments

A complex condition

Melasma – There is hope

Problems concerning skin pigmentation rank among the most common skin problems, having a huge impact on the lives of the patients.
Melasma is a complex disorder of facial pigmentation, which can be recognized by the appearance of blotchy dark brown patches of discolored skin to appear in a specific pattern across one’s face. Like most pigment problems it is harmless , but physiologically distressing to patients because of the effect it can have on their social and professional lives

Melasma occurs when there is overstimulation to the melanocyte (melanin producing) cells. Within this cell the melanosomes produce excess pigment and then deposit the pigment into neighbouring skin cells (keratinocytes) resulting in dark brown patches of skin. Factors that can stimulate the melanocytes into overdrive includes, a genetic predisposition, sun exposure, hormonal changes, medication, contraception and Hypothyroidism.

Who can get it?

It can appear in all ethnic groups, but people with darker skin tones are more prone, because of genetic predisposition and the fact that they do not burn in the sun and therefore do not wear sunblock daily.
It can affect both men and women, but 90% of the patients are women. Genetic predisposition could explain why Melasma tends to run in families. In many cases mother and daughter share not only Melasma, but also a similar distribution and severity level.

Where does Melasma occur?

It presents as areas of ill-defined brownish or dark patches, usually in a symmetrical pattern on a sun exposed area, usually the face. In particularly, melasma seems to favor the forehead, nose, cheeks and upper lip.

What is the cause?

The precise cause of melasma remains a subject of debate.
You can develop Melasma on your skin at any point in your life, but they can suddenly crop up in adult women due to changes in hormones, like a contraceptive pill, hormone therapy or pregnancy, but not always. Stress and some inflammatory conditions are also thought to be causes of melasma.
In addition to genetic and hormonal (including pregnancy) influences, researchers have identified several potential factors.
Hormones seems to be a factor in most of the women, But in other women, hormonal factors do not appear important. Other risk factors that can trigger and stimulate Melasma are the following:

• Sun exposure – this is the most important avoidable risk factor.
• Pregnancy may provoke melasma – in affected women, the pigment often fades a few months after delivery.
• Previous use of cosmetics or creams that caused your skin to be sensitive to the sun.
• A phototoxic reaction to certain medications may also trigger melasma.
• Melasma has been associated with hypothyroidism (low levels of thyroid hormone)

Can it be cured?

Melamsa is a chronic condition that can never be cured. The best course of treatment is a combination of in-office treatments with an optimised home skincare regimen
Melasma rarely resolves itself and is notoriously difficult to treat, but there are several treatment options that may improve the appearance.
Prevention is better than cure and the importance of a good quality sunscreen is of utmost importance

Treatment of Melasma

Melasma is very difficult to treat and often if the “internal factor” causing the pigmentation is not addressed it can remain.
Melasma can be treated and this may results in lightening, breaking up or fading the pigmentation, but may not resolve it completely
We commonly treat brown spots or patches with chemical peels which exfoliate the outermost layer of skin, removing the dark spots.

The Gold Standard of depigmentation treatment at Durban Laser Clinic is the Cosmelan depigmentation peel.
For those who cannot afford the down time of a deeper peel, gentler peels, light therapy and microneedling may bring some improvement by breaking up and fading the pigmentation. There are also new generation retinol peels that shows a lot of promise in the treatment of Melasma.

We prefer not to treat Melasma with laser or IPL treatments as the heat from these treatments may induce further pigment.

WHAT ARE THE TREATMENT OPTIONS FOR MELASMA

Cosmelan is being considered as the Gold Standard in pigmentation treatment. This very effective Depigmentation treatment, with a high safety margin, is designed to improve or remove the appearance of skin blemishes.
Cosmelan treatment’s principal action is the elimination of melanin patches on the face from melasma , sun damaged age spots. It is one of the very few effective pigmentation treatments that is completely safe for darker skin types.

Chemical peels can improve melasma by removing the outermost cells of the skin that contain the pigment. Chemical peels should be undertaken by an experienced practitioner as they could make the pigmentation worse, lighten the skin too much or cause scarring.

Microneedling: Needling with special serum can target and suppress the pigment-producing cells (melanocytes).

How can Melasma be managed?

Even if it is treated, melasma often returns after stopping the treatments and it will need ongoing maintenance treatments and products.
Incorporating a vitamin C into your morning skincare regimen to brighten pigment and provide antioxidant protection.
You should also use homecare creams with certain active ingredients like Ferulic, Kojic Acid, Niacinimide, which promotes melanin’s disintegration to get a more even complexion while diminishing the appearance of wrinkles.
Avoiding known triggers, such as birth control pills and hormone therapy.
Avoid any saunas and steam rooms as excessive heat will also stimulate the production of pigment
Do not use sun beds
Avoiding the sun and using sun-blocking creams.

What is the outcome?

The depth of the pigmentation ( if it is dermal of epidermal) will play a big role in the success of the treatment.
With the right treatment, many people with epidermal melasma can have a very good outcome.
You have to be patient with your treatment of Melasma. Sometimes it may take months of treatment to see improvement. It is important to follow your therapist’s advice. This ensures that you get the most benefit from treatment.
After your melasma clears, you will need to keep using the right homecare products and do some maintenance treatments from time to time.

Keywords: Melasma, uneven pigmentation, Brown spots on the cheeks, Chemical Peels, Skin brightening products, Sunblock, Cosmelan mask.