Melasma is a common skin condition of adults mostly women, in which light to dark brown patchy pigmentation develops usually on the face. Although it can affect both genders secondary to excess ultraviolet irradiation it is more common in women. It occurs in pregnancy and also can be caused or exacerbated by the oestrogen in the oral contraceptive pill. Melasma is usually very noticeable during the summer months when the face can actually appear dirty and fades a lot during the winter months. It has no cancerous potential.
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.
There is pigmentation on the face. It is usually fairly symmetrical, patchy, ill defined and light or dark brown depending on recent sun exposure.
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.