MELASMA

Melasma is the name given to a common skin condition which causes brown to grey-brown pigmentation on the face. Melasma is sometimes also referred as Chloasma.

Melasma pigmentation is usually symmetrical, the most common sites being forehead, cheeks, bridge of nose, chin and upper lip.It can sometimes also appear on other sun exposed parts such as neck and arms.

What causes Melasma?

Melasma is more common in females compared to males.

Melasma can have a genetic predisposition with more than one family member being affected.

Melasma is more common in people with darker skin. People from Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent are more likely to get melasma.

Melasma is caused by overproduction of melanin by the pigment cell which is then deposited under the skin (dermis)

Exact cause of melasma is unknow. Multiple factors seems to be a trigger for melsama

-Sun Exposure: Sun exposure is the most common avoidable trigger for melasma. UV rays from the sun trigger the pigment cells to produce more melanin. That is the reason why melasma is worse in summers and can come back after exposure to sun.

-Pregnancy– Hormone changes in pregnancy can be a common trigger of melasma

-Hormone changes – Other hormonal agents such as Oral contraceptive pill, HRT, Intrauterine devices and hormone implants can also trigger melasma

-Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries and cosmetics—these may trigger melasma, which may then persist long term

-Hypothyroidism

How to treat Melasma? 

Melasma can sometime fade itself once the triggering factor is removed. Most common scenario is resolution of melasma in pregnant females after delivery and in females on Pill after stopping the pill.

Sometimes Melasma can be very slow to respond to treatment, especially if it has been present for a long time.

General measures for treating melasma

– Cease the offending agent if known such as the Pill or HRT

– Use broad-spectrum SPF 50+ sunscreen applied to the whole face every day. Reapply every 2 hours if outdoors during the summer months.
– Wear a broad-brimmed hat.
– Use a mild cleanser, and if the skin is dry, a light moisturiser.

Topical therapy for treating melasma

– Hydroquinone :It is a common first line treatment for melasma. It is applied to the skin and works by lightening the skin.It is used as 2–4% as cream or lotion, applied accurately to pigmented areas at night for 2–4 months. You can get some of these without a prescription. These products contain less hydroquinone than a product that your GP or deramtologist can prescribe. This may cause contact dermatitis (stinging and redness) in 25% of patients. It should not be used in higher concentration or for prolonged courses as it has been associated with a bluish grey discolouration

– Kojic Acid : Kojic acid can cause irritant contact dermatitis

– Azelaic Acid is safe in pregnancy. Comes in the form of a cream, lotion or gel and is applied twice daily.

– Vitamin C (Ascorbic Acid)

– Topical Corticosteroids such as hydrocortisone works quiet well in quickly fading the pigmentation and reducing contact dermatitis caused by other agents

– Soybean extract

– Tranexamic Acid: Tranexamic acid has been used as a cream or injected in the skin

– Topical retinoids such as Tretinoin are very effective. Not to be used in pregnancy

The most common treatment is what is called “Triple therapy”. It includes a combination of Hydroquinone, moderate potency Topical corticosteroids and Tretinoin.

Other therapy for melasma treatment

– Superficial chemical peels with Alpha hydroxyacids including Glycolic acid and Lactic acid

– Intense pulsed light (IPL) lasers, Fractional lasers and Q-switched Nd:YAG lasers

– Microdermabrasion or Hydrodermabrasion