Dr Ian Webster
Dr Ian Webster

Melasma: Triggers and Treatment Options

Melasma is a skin condition where one gets symmetrical, brown diffuse pigmentation mainly on the face, in women with a darker skin type.

There are various factors that may trigger melasma

  • Sunlight which includes visible light
  • Hormonal factors such as pregnancy and oral contraceptives containing oestrogen
  • Certain fragrances and botanicals in skincare products in conjunction with sunlight can cause a phototoxic reaction, which results in hyperpigmentation

Initially, increased pigment lies only in the epidermis. This type of melasma is called Epidermal Melasma. With time, the pigment passes through the basement membrane and goes deeper into the dermis of the skin. This is called Dermal Melasma and is more difficult to treat.

Most people will, in fact, have mixed melasma – in other words an epidermal as well as a dermal component of melasma. This type of melasma can be diagnosed by shining a Woods lamp onto the skin or doing a Visia Skin Analysis.

Treatment Options

  • Discontinue any oral contraceptive containing oestrogen
  • Meticulous use of a high factor, broad-spectrum sunscreen daily throughout the whole year. Just one day in the sun without proper sunscreen can result in the melasma returning to its original state during or after treatment. Many sunscreens include a tint (Iron Oxide pigment) that not only helps to disguise the melasma but it also has the benefit of cutting out visible light. Recent studies have shown that visible light can trigger sun freckles as well as melasma. In addition, some of the better sunscreens also contain antioxidants which protect the skin against urban pollution and ground-level ozone.
  • The most effective initial treatment for the more stubborn melasma is topical Hydroquinone. Dermatologists worldwide use this prescription-only medication for a limited period of time, especially in people with darker skin types. In almost all cases there will be a lightening of the pigmentation but often not complete clearing.
  • Once the pigmentation is lighter, I usually prescribe various melanin inhibiting creams with a mixture of any of the following ingredients – Retinol, Kojic Acid, Tranexamic Acid, Resorcinol, Peptides, Niacinamide, Azelaic Acid, Ascorbic Acid, Arbutin and Liquorice extract, for use as a maintenance treatment. These non-hydroquinone products can be used for a long period of time and those containing Retinol will have, in addition, anti-acne as well as anti-ageing effects.
  • Tranexamic Acid taken orally has been shown to improve melasma. This, however, is a prescription-only medication with a few potential side effects.
  • Pycnogenol, a potent antioxidant derived from French Maritime Pine, taken orally as a supplement has also been shown to improve melasma.
  • Light, gentle chemical peels, Fractional laser as well as medical micro-needling such as Dermapen can help with the epidermal form of melasma. In my experience, you should be very wary of doing deeper more aggressive chemical peels like TCA peels for the dermal form of melasma, especially in people with a darker skin type.

Ideally, one should get advice from a Dermatologist and start the treatment of melasma earlier rather than later as the epidermal melasma may disappear spontaneously, just with a high factor, broad-spectrum sunscreen, and sun avoidance. It will also help to stop it from becoming dermal melasma.

It is important to remember that dermal melasma is a chronic condition that can be managed but not cured, so early intervention before it reaches this stage is imperative.

Products containing Retinols cannot be used if pregnant or breast-feeding and this needs to be discussed with your physician to identify safe alternatives.

Posted in LEARN / HOME PAGE CONTENT on September 4th, 2019.

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