Melasma is the coloration of the skin normally common during pregnancy, or as a result of birth control pills. Melasma is often characterized by the presence of brownish patches on the face, most commonly found on the nose, cheeks, forehead, or lips.
The use of oral contraceptives has been known to aggravate this condition thus prompting its sporadic appearance. The involvement of hormones also spikes up melasma making it a common occurrence.
Melasma is considered a chronic skin condition; however, various treatment techniques aim in reducing its appearance on the skin.
Who is most susceptible to melasma?
- Family history
Melasma is prevalent in individuals who have a previous family history of the condition. These individuals are most likely to have the condition as they grow older.
- Genetics and hormones
Women are also most susceptible to melasma, given the prevalence of the condition in pregnant women. This is due to the development of excess hormones, estrogen, and progesterone. Women between the ages of twenty to fifty are often affected by melasma.
Melasma can develop in postmenopausal women who are administered progesterone, but not in those who are given estrogen alone; this suggests that progesterone is a key factor in the development of melasma. Identical twins are also at a high probability of developing melasma.
- UV exposure
Individuals from areas of high sun exposure are also susceptible to melasma especially if they are light-skinned. The sun targets the light skin, therefore, prompting the development of brown patches on the surface.
UV light can promote lipid peroxidation in cellular membranes, releasing free radicals that may drive melanocytes to create more melanin. Sunscreens that block UV-B radiation do not block UV-A and visible rays which stimulate melanocytes to create melanin as well.
- Thyroid disease
Individuals at high risk of developing melasma often get thyroid disease. This is due to the presence of melanocytic and lentiginous nevi. This would suggest a link between the progression of melasma and the existence of pigmentation.
Melasma poses no harm to one’s health, but the change in appearance can be a daunting cosmetic issue making the individual feels uncomfortable in their skin. Melasma does not prompt the development of melanoma, therefore not bearing the risk of cancer.
However, there is a difference between melasma and hyperpigmentation due to the melanocyte-stimulating hormone increase in production.
Melasma treatment techniques
There are several ways to treat melasma that can either be home remedies or medically prescribed. Melasma is a difficult condition to treat, but not entirely impossible. A combination of treatment techniques is usually employed to provide an all-rounded and balanced treatment procedure.
The treatment techniques take into consideration various factors. Combination therapy might comprise a variety of treatment choices, such as prescription topical, in-office procedures, and altering your at-home skin-care routine, depending on the severity, probable causes, and face location of melasma. Each treatment case requires a customized approach for treated that will agree with the skin and not cause additional effects.
Therefore, melasma treatment should be carefully supervised and advised by the dermatologist before adopting them. Below are some treatment options available:
- Aloe vera
The benefits of aloe vera on the skin aim in treating melasma. Melasma dries up the skin, therefore, aloe vera moisturizes thus rehydrating it.
- Topical options
Topical creams are customized and compounded by the dermatologist for every individual to treat melasma. The topical cream takes into consideration individual skin type, their prevalence of melasma to create the right amounts of prescription strength that will prompt treatment.
Hydroquinone, tretinoin, kojic acid, vitamin C, and topical tranexamic acid are common ingredients of the customized and compounded topical cream the dermatologist will prescribe. Hydroquinone, the first ingredient, is one of the most effective though controversial, whitening agents available, recommended for reducing hyperpigmentation. It can be found in over-the-counter skin-care products at a concentration of 2%, but dermatologists frequently prescribe it at higher concentrations for melasma. However, due caution should be taken as long-term use can cause inflammation, skin sensitivity, irreversible depigmentation, and, in rare circumstances, ochronosis, a blue or blackening of the skin. This is why hydroquinone is only found in modest concentrations: 2% in over-the-counter products and 4% in prescription creams.
- Chemical peels
Chemical peels as a second line of treatment for melasma. These are done as in-office procedures due to their sensitive nature. For instance, Microdermabrasion or micro-needling may assist the condition by allowing the other substances to enter the skin surface as they remove the top layer of skin. Therefore, chemical peels should be done in the office to prevent skin aggravation.
- Laser treatment
When melasma does not respond to topical therapies as the first line of treatment, laser treatment is worth considering. Inflammation and hyperpigmentation are very likely to occur. The number of people who can be treated with lasers is limited by small sample numbers in clinical trials.
Laser therapy is done in-office treatment for careful and accurate results in treating melasma rather than aggravating it. Lasers work on the skin to break up the existing melasma pigments. The heat energy can however produce pigmentation thus the need for a professional. The Clear + Brilliant laser is the safest and most effective treatment for melasma.
Sunscreen is needed for proper skin maintenance. Sunscreen helps prevent new melasma from forming. High SPF sunscreen works wonders with preventing melasma by creating a protective barrier between the skin and the UV rays from the sun. Individuals from high sun exposure areas should maintain a constant routine of sunscreen application at least twice a day to create a concrete barrier.
It is important to have a skin maintenance plan to ensure that melasma does not return. A single day without sunscreen or proper skin maintenance can prompt the formation of new melasma thus cutting back the treatment process.
- Oral medication
Melasma can also be treated with tranexamic acid taken orally. Despite its history as a treatment for excessive menstrual bleeding, recently been proved in tests to considerably improve melasma by a different mechanism than all of the other topical therapies that we have used in the past. Tranexamic acid, like hydroquinone, is intended for short-term therapy but shows benefits rather quickly, often within the first month.