Melasma is a common form of dark skin pigmentation that usually appears on the forehead, cheeks, upper lip and chin. It can appear as a light tan, dark patchy brown or blue-grey skin discoloration.
Melasma is caused by overactive melanocytes in the skin. Melanocytes are the cells responsible for producing melanin, a pigment that darkens the skin and protects it from harmful UV rays.
Melasma affects about 45-50 million people world-wide but is more common in women. Over 90% of those affected by melasma are women aged 20 to 50 years. It is more common in women with olive or darker skin types, including those of Asian, Mediterranean or Middle Eastern heritage.
Melasma is thought to be caused by an underlying genetic condition that can be exasperated by hormonal factors, skin diseases and sun exposure. When melasma occurs during pregnancy, it is referred to as chloasma, or “the mask of pregnancy.”
Treatments can include topical medications, such as 4% hydroquinone, chemical peels, fraxel lasers and natural whitening creams. Care must be taken with chemical peels and laser treatment because, if treated inappropriately, the melasma and pigmentation problems can actually worsen.
This condition can re-occur so having both a treatment and prevention program in place is the foundation to achieving more long lasting results. Prevention is largely aimed at protecting the face from sun exposure and/or sun avoidance
What Causes Melasma?
According to MedicineNet.com the exact causes of Melasma are not known but experts believe there are several triggers.
- Genetic– some people may have a family history of melasma and others might be pre-disposed to this condition. For example, Melasma is more common in females and particularly those of darker skin races, such as Asian, Mediterranean or Middle Eastern extraction.
- Hormonal – Some people will have melanocytes that are more sensitive to changes in hormonal levels. Changes caused by pregnancy, birth control pills (oestrogen) and hormone replacement therapy can often stimulate the pigment producing cells, resulting in excessive pigmentation.
While pregnant women experience increased levels of oestrogen, progesterone, and melanocyte-stimulating hormone (MSH) in the 2nd and 3rd trimesters of pregnancy it is thought that pregnancy-related melasma is caused by the presence of increased levels of progesterone rather than oestrogen and MSH.
- UV exposure (sunlight) – Most people with melasma are seen to have a history of daily or frequent sun exposure. Even brief exposure to UV light can stimulate the production of melanin in the skin so the use of a good sunscreen is an important part of treating melasma.
- Skin Irritation – active inflammation of the skin from heat, acne outbreaks or skin disease can sometimes cause melasma.
Types of Melasma
There are different types of melasma that vary in their pigmentation pattern and location.
- Epidermal melasma is an excess of melanin in the superficial skin layers. It mostly appears as a tan color.
- Deep or dermal melasma is found lower in the dermis of the skin. It is usually a darker color and is best treated with a combination of creams and/or Fraxel Laser.
- Mixed type melasma includes both the epidermal and dermal types and is often the most difficult to treat. This form of skin darkening is usually more common in darker skinned races.
Step 1: Use a good sunscreen
The first step is to use a sunscreen with a 50+ SPF (sun protection factor) that has physical blockers, such as zinc oxide and titanium dioxide. It is important to have a sunscreen that blocks both UVA and UVB sun rays. Using a sunscreen daily will enhance the effectiveness of other melasma treatments.
Step 2: Whitening Creams
This next step aims to inhibit the overactive melanocytes in the skin (the pigment producing cells).
To inactivate or slow the production of melanin, specially formulated creams with hydroquinone or other bleaching agents may be prescribed. Over the counter and standard prescription strength hydroquinone treatments vary between 2% and 4%. Higher dosages may be given under the supervision of a doctor in a medical program. This can lead to better results but carries an increased risk of side effects.
Hydroquinine (HQ) can lead to skin irritation and people who undertake HQ treatment for prolonged periods of time are at risk of developing a side effect called ocronosis – a blue-grey skin discoloration. Hydroquinone is also thought to be carcinogenic and has been banned from use in cosmetics in some countries so consult your doctor if unsure.
Recent scientific research has increased our understanding of melanin formation which has led to the creation of a new range of more gentle skincare formulations, designed for treating dark skin pigmentation.
To treat your melasma at home look for a natural skin whitening cream like Meladerm that contains ingredients like kojic acid, bearberry extract, mulberry extract and Vitamins C and A. These are all proven skin whiteners from nature that act to inhibit melanin production in the same way as hydroquinine, but without the potential side effects.
Step 3: Chemical Peels or Laser Skin Therapy
Melasma usually responds well to lightening creams but treatments to help clear the excessive pigmentation can also include chemical peels or microdermabrasion to exfoliate the skin and, in some cases, laser therapy.
Chemical peels can help speed up the process of treating melasma by gently exfoliating the excess pigment from the deeper layers of the skin. Chemical peels work to regenerate the skin at varying depths. Superficial peels remove the dead layers of the skin and can help improve uneven pigmentation, whilst medium depth peels target the deeper layers of the epidermis. The types and concentrations vary for different skin types but 20%-70% Glycolic Acid Peels (AHA peels) are commonly used. They are well tolerated by the skin and there is no downtime with this type of peeling, however, in darker skin types, a more conservative peel regime is needed to reduce the chance of post inflammatory darkening of the treated skin.
Microdermabrasion uses fine diamond chips or aluminium oxide crystals to exfoliate and remove dead skin cells on the top layer of the skin. It can improve the appearance of melasma but multiple treatments may be required to achieve the best result.
Laser resurfacing using Fraxel laser can give good results in resistant cases of melisma but it is never the first line treatment. The Fraxel laser targets the surface pigment which limits inflammation of the skin, however; make sure any treatment is delivered by a doctor who has experience using this type of laser.
There is no guarantee that your melasma will improve with the treatments listed here and studies show that laser treatment can often worsen some types of melasma, leading to hyperpigmentation (further darkening) or hypopigmenation (white patches), so it should always be used with caution.
Laser is generally reserved for cases where other treatments have failed, or if patients require quicker fading of pigmentation