Melasma is the most common skin problem. Melasma is a chronic skin condition with symmetrical, blotchy, brownish to blackish facial pigmentation typically involving face areas such as cheeks, bridge of nose, forehead, above the upper lip, and chin.
It may appear in other areas of the body exposed to the sun like neck, chest, or arms. It’s also called chloasma, or the “mask of pregnancy” as it is so common during pregnancy. It is common, harmless and some treatments can help in get-rid of melasma.
Clear Skin Laser Centre performs multiple combo treatments for all skin hyperpigmentation treatments, with US FDA approved advance laser technologies which deliver outstanding results; we perform best laser treatment for Melasma.
The cause of melasma is complex. In general, the pigmentation is due to overproduction of melanin by the pigment cells of the skin. Melasma is more common in people who have brown skin because they have more active melanocytes compared to people with lighter skin. There is a genetic predisposition to melasma, with at least 1/3 rd have family members affected.
Abnormal exposure to sunlight (Ultraviolet & Visible rays) stimulates the melanocytes, which in turn increases melanin production results in increasing pigmentation of melasma (worsening) and recurrence in summers.
Externally taken hormones such as birth control or oral contraceptives pills(containing estrogen and progesterone), hormone replacement therapy, intrauterine devices and implants, and physiological hormonal changes, as seen during pregnancy, stress, thyroid disorders are all known to trigger melasma.
Such as anti-epileptic drugs, anti malignant drugs, and few other photosensitive drugs may trigger melasma.
Scented or deodorant soaps, toiletries, cosmetics may cause a phototoxic reaction leading to an increase in melanin production and worsens melasma.
Melasma can be separated into epidermal, dermal, and mixed types, depending on the level of increased melanin in the skin.
The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes in the outer layer of skin called as Epidermal melanosis.
Here the patches are well-defined; dark brown in color, appears more obvious under black light and responds well to treatment.
Melanin deposition in the inner layer of the skin, the dermis is called as dermal melanosis.
The patches are ill-defined border, light brown or bluish, unchanged under black light, and responds poorly to treatment.
Mixed melasma is the most common type of melasma , the pigment is distributed in both the layers of the skin.
The patches are bluish-grey, light and dark brown in colour. A mixed pattern is seen under black light and responds partial treatment.
Classified upon the area of involvement three main patterns which are common are:
Centrofacial pattern: forehead, cheeks, nose and upper lips
Malar pattern: cheeks and nose
Mandibular pattern: jawline
There is good news in this new era of science. There are plenty of ways to reduce the appearance of melasma. Melasma responds very slowly to the medical line of treatment especially if it for a long time or dermal type and if it has vascular predominance. Treatment is required for individuals who are cosmetically concerned.
Most of these are tyrosinase inhibitors and are the mainstay of treatment. The aim is to prevent new pigment formation by inhibiting the formation of melanin by the melanocytes.
As cream or lotion, applied accurately to pigmented areas at night for 2–4 months. It may cause contact dermatitis (stinging and redness) in a few patients. It’s better to avoid using in higher concentration and for a prolonged time, may cause a bluish-grey discoloration of the skin, known as hydroquinone-induced ochronosis
Retinoids works by increasing skin cell turnover and allow fresh cells to form quickly. Tretinoin is the most common retinoid used and available n combination with hydroquinone or hydrocortisone. It enhances the efficacy of hydroquinone and is usually given secondary to hydroquinone. Triple combination; containing hydroquinone, tretinoin, and a corticosteroid is a good option if melasma does not respond to single drug.
There are number of non-hydroquinone creams available skin lightening creams which does not have bleaching effect on skin, but acts on pigment producing cells that reduce the pigmentation of the skin. The most common active compounds are Kojic acid, Azelaic acid, Ascorbic acid, Arbutin, Niacinamide, Glycolic acid and Tranexamic acid.
Tranexamic acid inhibits plasmin normally used orally to stop bleeding. It reduces the production of prostaglandins, the precursors of tyrosine. It is used in low doses and reported to be effective and safe in the treatment of melasma.
Glutathione is a systemic skin whitening agent but has potential severe adverse effects.
Here are some following interventional dermatological procedures which are advised if conventional treatment fails
Chemical peels should be done under the supervision of a dermatologist, will choose the type and strength of the chemical peel (glycolic acid, hydroquinone, salicylic acid) best suited to you. The superficial skin is peeled off, which allows topical tyrosinase inhibitors to penetrate more effectively.
Mechanical exfoliation by microdermabrasion, vacuum suction, and abrasive material is used to exfoliate the top layers of skin. Multiple sessions will be needed, in combination with sunscreen and other creams to get the optimum results.
Melasma is harmless; however, these patches can cause distress and embarrassment. There is good news in this new era of Laser technology. There are plenty of laser treatments for Melasma to reduce the appearance of the melasma.
Laser treatment for melasma is ideal to treat skin hyperpigmentation & melasma, this will destroy the pigment while leaving the melanocyte cells alone.
Q-Switch Nd: YAG lasers, Picoseconds lasers, Fractional Erbium Glass lasers or a light based- Intense Pulse Light (IPL) are better options. Pigment lasers such as Q-switch Ruby & Alexandrite to be used with caution. Pico lasers due to its photo-acoustic effect showing more promising results than the photo-thermal effect of nano q-switch laser.
Treatment needs to be regular to avoid recurrence on abnormal exposure to the sunlight.
· Physical protection: use a broad-brimmed hat round the year.
· Sun protection: Sunscreen with SPF of 50+ applied to the whole face daily, round the year. It should be reapplied every 2 hours if outdoors during the summer months. Sunscreens containing iron oxides are preferred. Habitual use of sunscreen will enhance the effectiveness of other treatments.
Discontinue hormonal contraception
We at Clear Skin Centre, Kurnool have an immense experience to provide specialized melasma treatment plans which ensure permanent solutions. We guarantees a lower cost of treatment for melasma with the USFDA approved and world class laser technologies.