Hyperpigmentation of Face / Melasma

What is Melasma?

Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

Who gets Melasma?

  • Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others. The precise cause of melasma is unknown.
  • Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a brown skin type who are living in regions with intense sun exposure are particularly susceptible to develop this condition.
  • People with a family history of melasma are more likely to develop melasma themselves.
  • A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called Chloasma, or the “mask of pregnancy.” Melasma may disappear after pregnancy; it may remain for many years, or a lifetime.
  • Birth control pills may also cause melasma.
  • Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes in the skin. People with skin of colour have more active melanocytes than those with light skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.
  • It may also be noticed in apparently healthy, normal, non-pregnant women where it is presumed to be due to some mild and harmless hormonal imbalance.
  • Any irritation of the skin may cause an increase in pigmentation in dark-skinned individuals, which may also worsen melasma. Melasma is not associated with any internal diseases or organ malfunction.

How is Melasma diagnosed?

Because melasma is common, and has a characteristic appearance on the face, most patients can be diagnosed simply by a skin examination with a Woods lamp. Occasionally a skin biopsy is necessary to differentiate melasma from other conditions.

How is Melasma treated?

While there is no cure for melasma, many treatments have been developed.

  • Sunscreens are essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. A SPF 25 or higher should be selected.
  • In addition, Antioxidant solutions, physical sunblock lotions and creams may be used to block ultraviolet radiation and visible light. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors. A significant amount of ultraviolet rays is received while walking down the street, driving in cars, and sitting next to windows.
  • Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as this may worsen melasma.
  • If melasma develops after starting birth control pills, it may improve after discontinuing them.
  • Melasma can be treated with skin lightening creams while continuing the birth control pills. A variety of creams are available for the treatment of melasma. These creams do not “bleach” the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells. Typically, these creams contain Hydroquinone, which inhibits formation of new pigment. Bleaching creams must be applied for at least 6 months to obtain a worthwhile lightening of pigmentation. Even then, just a “whiff” of summer sun can darken the pigment again and spoil months of hard work. Normally, it takes about three months to substantially improve melasma. Remember, a sunscreen should be applied daily in addition to the lightening cream. Apply the cream first then the sunscreen on top.
  • Creams containing Tretinoin and Glycolic Acid are used in combination with hydroquinone to enhance the depigmenting effect.
  • If progress is slow a hydroquinone cream with Tretinoin may be used. Tretinoin always causes a degree of pinkness and peeling of the facial skin which can be controlled by starting with a little then building up. A sun screen must be applied as well. Tretinoin MUST NOT be used in pregnancy.
  • Chemical peels and laser surgery with potent lasers such as the Instalite laser (Q switched Nd YAG laser) may help melasma, but results have not been consistent. These procedures have the potential of causing irritation, which can sometimes worsen melasma. Generally, they should only be used by a dermatologist in conjunction with a proper regimen of bleaching creams and prescription creams tailored to your skin type. People should be cautioned against non-physicians claiming to treat melasma without supervision because complications can occur.

Management of melasma requires a comprehensive and professional approach by your dermatologist. Avoidance of sun and irritants, use of sunscreens, application of depigmenting agents, and close supervision by your dermatologist can lead to a successful outcome.

It is important to follow the directions of the dermatologist carefully in order to get the maximum benefit from your treatment regimen and to avoid irritation and other side effects.

What is the procedure at Kosmoderma?

  • During the consult, the skin is tested to determine its condition
  • Based on the test results a home care regimen is prescribed and your skin is given initial peel prep. The home care is just as important as the clinic procedures
  • After 2 weeks, chemical peels – Glycolic / Lactic Acid / TCA / Phenol / Resorcinol / Designer Peel treatments are begun. The spacing and number of sessions depends on the severity of melasma and your skin condition
  • We recommend between 4 – 6 sessions of superficial level peels 2 weeks apart followed by 4 deep peels a month apart
  • If the melisma is resistant to peels, we may recommend for Instalite laser in combination with Tranxemic acid injections.
  • Oral antioxidants to boost the skins immunity against UV is prescribed.
  • The home care is continued post treatments to maintain the results.