What is Melasma?
Melasma is a form of facial pigmentation that effects both men and women. It occurs when cells become hyperactive and produce too much pigment in certain areas of the skin resulting in large discoloured patches. These discoloured patches are typically darker brown, tan and grey patches on the skins surface. It is commonly seen on the cheeks, bridges of the nose, chin, forehead, and above the upper lip. Larger portions of the body such as the neck and arms, can also be affected by melasma. Melasma affects women much more frequently than men. Individuals with Fitzpatrick IV, V and VI are more likely to develop melasma due to the skin having much more active pigment producing cells.
It is suspected that the interaction of genetics, UV exposure, hormone replacement therapy, pregnancy, contraceptive pills, darker Fitzpatrick skin types, all play a significant role in the cause of this condition. Melasma can be worsened by not only the UV rays but also heat and visible light. It is important that people adhere to preventative measures in order to stop the severity of their condition.
Melasma Treatment & Prevenetive Measures
The first step when treating melasma is that it is diagnosed properly by a dermatologist, from there your dermatologist will be able to confirm that it is melasma and to help determine what is causing it. Treating melasma is unlikely to be effective if the underlying cause isn’t addressed.
As mentioned melasma is triggered by hormonal factors such as pregnancy or birth control pills, if a woman were to stop taking birth control pills or deliver her baby she may potentially see an improvement, the discoloured patches may fade over time. However, in many cases people have melasma for years or even their entire life and have a hard time trying to improve it.
When considering treatment overall, topical treatment has proven to be very successful. Topical hydroquinone is often used as the first line of treatment by dermatologists. Once applied will slowly overtime lighten the discoloured areas. It works by decreasing the production of pigment in the skin. Your doctor may recommend combining it with tretinoin, corticosteroids or antioxidants. Some other commonly used options are azelaic acid or kojic acid which works to lighten the areas effected. Furthermore, topical retinol and retinoid treatments once applied will help speed up the body’s natural cell turnover process, this may help dark patches clear more quickly than they would on their own.
The Q-switch laser is a treatment option available to people trying to improve their melasma. The laser works by using very short nanosecond pulses that help to shatter the melasma pigmentation. The short pulses deliver minimal heat energy to the skin and therefore have more of a mechanical effect on the pigmentation rather than a heating effect. This effect allows the breakdown of pigmentation without heating the skin and worsening of the pigmentation. The laser energy breaks apart the abnormal pigment into smaller particles and then effectively removes it using the body’s lymphatic drainage system.
It is a quick procedure that most people find very comfortable. You will hear a slight snapping sound when the laser is fired and may feel a slight tingling or warmth. All skin tones, from light to dark, can be safely treated with this laser. Women who are pregnant or nursing cannot be treated and those who have received accutane or any oral Vitamin A acne therapy cannot be treated for 6 months after their last dose. An effective treatment regimen is 8 sessions spaced 1 to 4 weeks apart. The downtime is minimal usually only mild redness for a day. Generally, most people go back to work the day after treatment.
There have been various research studies conducted using platelet rich plasma as a way of treating melasma. Although the research is limited the studies that have been done have deemed it to be a useful and new therapeutic option.The results demonstrate that plasma rich platelets can partially improve melasma lesions. Platelet rich plasma uses the healing power of your own platelets. The growth factors from the plasma cause the release of stem cells that already exist in the skin. They then trick the skin into thinking it needs to heal itself resulting in new tissue, collagen and new blood vessels. Further research will have to be carried out in this area but it is another positive step towards effectively treating melasma.
When finding a treatment that best suits you it is important that people are careful when seeking out the different options. When a treatment is not tailored to a specific skin type or the treatment is carried out by someone inexperienced, new skin problems can easily occur such as rebound melasma or hyperpigmentation. These conditions can potentially worsen the pigmentation because the initial treatment irritates the melanocytes. People should do their research and consult with someone experienced in this area in order to receive the best care and results.
Australia as a continent has very strong UV radiation levels, protecting your skin from the sun is absolutely essential especially in prevention of further development of melasma. Wearing a wide-brimmed hat and sunglasses, and using sunscreen with a sun SPF of 50 or higher is encouraged. Using a sunscreen that has broad spectrum coverage, containing physical blockers such as zinc oxide or titanium oxide to block out the sun’s rays. These are necessary steps individuals should take in order to decrease the severity of this condition.
While melasma doesn’t present any health risks and isn’t painful it can lead to significant emotional distress. A lot of women and men experience a decrease in self-confidence and self-esteem, it has the ability to increase self-consciousness because of the noticeability of the melasma. It is important that awareness is brought surrounding this condition and for people to be aware that there are measures they can take to lessen the severity.
Managing melasma is a marathon and not a sprint. It is an extremely complex condition and has proven to be very hard to treat. There is no overnight fix so it is important for people to be patient. Melasma will be quick to return if you’re not careful about sun protection. So, long-term maintenance requires an ongoing commitment to protecting your skin. With an accurate history and examination, following the right treatments and preventative measures this condition can be safely improved.