Melasma

What is Melasma?

Melasma is a very common patchy brown, tan, or blue-gray facial skin discoloration, usually seen in women in the reproductive years. It typically appears on the upper cheeks, upper lip, forehead, and chin of women 20-50 years of age. It is uncommon in males. It is thought to be primarily related to external sun exposure, external hormones like birth control pills, and internal hormonal changes as seen in pregnancy. Most people with melasma have a history of daily or intermittent sun exposure, although heat is also suspected to be an underlying factor. Melasma is most common among pregnant women, especially those of Latin and Asian descents. People with olive or darker skin, like Hispanic, Asian, and Middle Eastern individuals, have higher incidences of melasma.
Prevention is primarily aimed at facial sun protection and sun avoidance. Treatment requires regular sunscreen application, lightening products containing the ingredient Kojac and other fading creams.

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What causes Melasma?

The cause is not fully understood although it occurs quite frequently in pregnancy and in the majority the condition fades after the delivery. Some acquire it while taking oral contraceptives although it doesn’t always fade after discontinuation of these.  All patients with melasma find that it is increased with increased exposure to UV light and this must indeed be the cause in males where oestrogen is not contributory.

What does Melasma look like?

There is pigmentation on the face. It is usually fairly symmetrical, patchy, ill defined and light or dark brown depending on recent sun exposure.

Management:

Explanation and solar protection are the most important as the condition is difficult to treat. Fair skinned individuals have the best prognosis and may recover completely after pregnancy or stopping the oral contraceptive pill.

Proper skin care is essential in melasma.  I would start the day with either an AHA or BHA cleanser which wakes up the skin cells and makes them respond better to active products. Sunscreen daily is very important.  Reform or Image  sunscreen is a once daily factor 30 application with DNA repair.  It has zinc and titanium oxide which gives a complete physical block.  Image or Reform Vitamin C 10% or 20% is a very powerful anti-oxidant and offers additional sun protection and is a whitening agent. Image or Reform Retinol 1% mixed with polyvitamins is an excellent serum for pigmentation and anti-ageing also.  It also improves fine lines, pigmentation and ageing, it is not to be used in pregnancy or breast feeding.  If these products are combined with a home derma roller there is increased penetration of about one thousand into the skin so results will be superior.

If the pigmentation is very severe or only improves moderately with the above hydroquinone4% can be added in for a short period which again is excellent for increased pigmentation. These products are all available for purchase at Revive Beauty & Laser Clinic.

The products will usually need to be used long-term for maintenance but are excellent for skin anti-ageing. If the pigment still doesn’t clear to the patient’s satisfaction then at a review visit about 6 weeks after starting the products a peel can be performed.  Peels can improve melasma but can also worsen it so caution is necessary.  Several peels may be necessary.

Lasers can also be used.

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