Melasma – A Guide to Treatment Methods

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Summation

  • A procedure in which a chemical solution is usually applied to the affected part in order to remove the uppermost layer of the skin.
  • In many other cases, a combination of factors including UV exposure and age likely play a role in the development of melasma.
  • Results from a recent large global survey of 324 women with melasma suggested that a combination of known triggers, including pregnancy, hormonal contraception, family history, and sun exposure, contribute to the onset of melasma.

You may be wondering what causes strange brown marks on your face and whether it can affect your overall health. If you want to know the details of this condition and treatment options, keep reading.

Melasma – “Mask of Pregnancy”

Melasma is a common acquired hyperpigmentation disorder that appears as light to dark brown pigmentation on sun-exposed areas of the face and neck. Melasma is generally prevalent in women after pregnancy and in those women with darker skin tones.

The causes of melasma are unknown but many different major etiological factors may play an important role. These include genetics, exposure to ultraviolet (UV) radiation, and hormonal changes (e.g. using the oral contraceptive pill, during pregnancy). The other possible factors include thyroid dysfunctions, cosmetics, phototoxic and antiepileptic drugs, ovarian and hepatic dysfunction, and nutritional deficiencies

Results from a recent large global survey of 324 women with melasma suggested that a combination of known triggers, including pregnancy, hormonal contraception, family history, and sun exposure, contribute to the onset of melasma. The results of this study showed that melasma was not always associated with pregnancy or a history of contraceptive use. In many other cases, a combination of factors including UV exposure and age likely play a role in the development of melasma.

Treatment Methods for Melasma

The best and most effective treatment options for melasma are mentioned below:

1.   Topical Creams:

Topical creams can be used if the melasma is mild. However, sunscreen should also be used to ensure that the cream works properly and that spots do not recur.

Some of the topical treatments that are available include:

  • Vitamin A Creams: These creams containing tretinoin can be used as a stand-alone treatment or can be combined with other medications. They can even cause skin irritation. Hence, their use should be closely monitored under the direction of a certified dermatologist.
  • Combination Topicals: Currently, hydroquinone, topical steroid and retinoid combination creams are effective for melasma management.
  • Hydroquinone Cream or Lotion: (4-8% alone or other active ingredients) is the most extensively used treatment for managing melasma. The more concentration of hydroquinone, there will be higher chances of irritant dermatitis (eczema).
  • Azelaic acid: In order to treat the severe cases of melasma, 20% azelaic acid is effective to use.

2. Oral Medications and Supplements

You may generally get oral medications prescribed by your skin doctor. Skin specialist often prescribe oral medications along with other treatments. One commonly prescribed medication is tranexamic acid, which reduces skin pigmentation and redness.

3. Medical Procedure

If melasma is so severe that topical medications do not work, your doctor will usually advise you to seek medical attention. There are numerous different kinds of medical procedures:

    Chemical Peeling:

A procedure in which a chemical solution is usually applied to the affected part in order to remove the uppermost layer of the skin. Within a few days, the skin on your face will peel off and a new layer of smoother, more even skin will grow.

Chemical peels have been used with varying success in treating melasma. Multiple treatments are needed to obtain effective results or benefits. They are best used with a topical cream. The types of peels used include:

  • Glycolic acid peels (the most commonly used peel).
  • Low-strength trichloroacetic acid peels.
  • Retinoid peels.
  • Lactic acid peels.

Caution: Due to the high complication rate, medium to deep chemical peels should not be used to treat melasma. If you have dark skin, dermatologists mostly recommend using a light peel.

    Microdermabrasion

The microdermabrasion treatment uses minimal abrasive equipment to gently sand the skin to remove an uneven  or thicker outer layer, and has other multiple benefits. This kind of skin rejuvenation has been used to effectively treat the stretch marks, minor scarring, sun damage and discoloration.

One session of microdermabrasion will cost you 4000-5000 Pak rupees in Pakistan.

Microdermabrasion is a safe and successful procedure for all types of skin. The exfoliating crystals do not cause any damage to the skin as they are fine. There is no chance of scarring or infection as microdermabrasion requires no anesthesia. The treatment is painless and may take an hour or less. There is no downtime for this procedure, and doctors usually prescribe moisturizers or skin care products to prolong the results.

     Laser and Light-Based Treatments

Laser and light-based treatments should only be done in complicated cases when the therapies are ineffective in function. A detailed discussion with a dermatologist is essential regarding the suitability of laser therapy for melasma.

Because of the high risk of complications, a small test treatment is initially performed to ensure that the pigment is not causing a darker reaction. It may take a few treatments to observe positive improvement. Only specific lasers are used and must be used with extreme caution and with the guidance of a dermatologist.

    Q-switched Nd: YAG laser:

The most effective laser treatment for melasma at lower power settings. It emits a longer, near-infrared ray of 1,064 nm that has strong ability to penetrate into the deeper regions of the skin. It will take several treatments over several months to see positive results.

    Pico Laser:

Pico Technology is believed to be one of the most advanced laser treatments available in Pakistan. It is a non-invasive, non-surgical laser skin treatment that can be used to detect common skin imperfections, including scars caused by sun damage and acne scars.

  •     Vascular Laser Treatment:

Vascular lasers particularly target abnormal or unwanted blood vessels in the skin with lesser damage to surrounding normal skin structures. Modern vascular lasers are completely very safe and effective when used by well experienced dermatologists.

    Intense Pulsed Light (IPL) :

Intense pulsed light may only be effective in some cases of epidermal melasma in light skin types. It has to be noted that even if treatment is successful, reversion of the condition is common.

An Apparent Treatment for Melasma:

Tranexamic acid has been observed as a promising approach for melasma. It is used in tablet form by dermatologists chosen for non-reactive melasma creams. Further evaluation of the effectiveness of this treatment requires more research or clinical trials.

Modern Q-switched picosecond lasers may be more effective than nanosecond Q-switched technology. However, this treatment needs further research in advance. It is recommended for use in the management of melasma.

Attention: Early consultation is the most important because an accurate diagnosis of melasma must be made. A detailed history taking is mandatory to reveal the properties of recurrent melasma.

Adopt Lifestyle Habits to Prevent Melasma:

Melasma can ruin some people’s confidence. Although treatment is a bit complicated, there are several things you can do to minimize your risk of developing melasma.

    Apply sunscreen daily

Since the main cause of melasma is sunlight, sunscreen plays an important role in preventing melasma. Try to use a sunscreen regularly that inhibits  both UVA and UVB with a 30 SPF (Sun Protection Factor).

    Wear a hat

Remember to wear a hat when going out as direct sunlight can cause hyperpigmentation and cause melasma.

    Use mild skincare

Harsh skin care can cause irritation and cause melasma. Always try to use those products that do not burn or cause itching, specifically if you have sensitive skin.

In Conclusion:

Melasma is harmless and usually treatable. With the various treatments you can choose to treat melasma, there are ways to prevent melasma from developing on your skin.

Before starting melasma treatment, talk to the dermatologist in Lahore to determine which treatment to use based on your medical history and skin condition.

FAQs:

1.   Does melasma go away after menopause?

As far as we know, melasma is caused by a combination of female hormones (mainly estrogen) and UV/sunlight, so they tend to improve or disappear after menopause.

2.   Does melasma disappear with age?

Most cases of melasma disappear with time, especially with good protection from sunlight and other sources of light.

3.   Does lack of estrogen cause melasma?

While melasma may develop in a postmenopausal woman given progesterone, it is not seen in those given estrogen alone; this indicates that progesterone plays a primary role in the development of melasma.

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