Dr Ian Webster
Dr Ian Webster

Melasma: Triggers and Treatment Options

Melasma is a skin condition where one gets a diffuse, symmetrical type of pigmentation that usually occurs in women with a darker skin type. It is commonly found over the forehead, cheeks, and upper lip.

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.

The epidermal form of melasma may disappear spontaneously as the hormones settle after pregnancy and also with consistent use of high factor, broad-spectrum sunscreen. The mixed or dermal forms of melasma are unfortunately more stubborn to treat.

Treatment Options

Melasma is difficult to treat and the specialist help of a dermatologist is often required to make the correct diagnoses and to oversee the primary treatment.

  • 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.)
  • Pycnogenol, a potent antioxidant derived from French Maritime Pine, taken orally as a supplement has also been shown to improve melasma.
  • Hormonally-induced pigmentation is difficult to treat (once it is noticed) as hormones have a physiological influence 24 hours a day. If caught in the early stages, it is preventable with sunscreen.
  • Many sunscreens include a tint (Iron Oxide pigment) that not only helps to disguise the melasma but 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 that protect the skin against urban pollution and ground-level ozone.

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 breastfeeding and this needs to be discussed with your physician to identify safe alternatives.

Posted in LEARN / LEARN on September 4th, 2019.

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