Melasma Treatment

The risk of having melasma is higher in individuals of a particular race or skin tone and type. Generally, people with medium or darker skin tones are more prone to this condition because they have more active melanocytes than people with lighter skin. It also commonly affects women who are of Latin, Hispanic, Asian, Black, or Native American descent.

Women who are in their second or third trimester of pregnancy are also at an increased risk for melasma. Melasma is thought to be linked to hormonal changes and can often occur in pregnant women. This skin condition is sometimes called ‘the mask of pregnancy’. Women are more likely to develop patches of skin discoloration than men.

Melasma is related to the melanocytes or the pigment-producing cells in the skin. Melanocytes are found in the basal cell layer at the epidermis and they are mainly responsible for creating melanin that gives the skin its color.

It’s highly likely that dark patches of melasma appear when the melanocytes are stimulated and produce too much pigment. There are several factors that can contribute to the overproduction of these skin cells like

• Sun exposure: The ultraviolet light from the sun can cause the skin to produce more melanocytes and worsen the existing symptoms of melasma.
• Hormone changes: Pregnancy can cause hormone fluctuations and the increased levels of estrogen and progesterone can influence melanin production. Additionally, taking birth control pills and hormone replacement therapy can lead to melasma.

The first signs of facial pigmentation of melasma are tan, gray-brown, dark, and sometimes bluish patches on the skin. The color of pigmentation can vary depending on the person’s skin tone and the severity of the condition. But generally, melasma patches should appear darker than your natural color.

Some cases of melasma can look like spots that resemble the appearance of freckles. It is a totally harmless skin disorder with no other symptoms of itching or pain. It is mostly a cosmetic issue that can affect your overall self-confidence in your appearance.

Melasma can often develop on the face, especially the cheeks, chin, above the upper lip, nose, and forehead. It can also form on other areas that get sun exposure such as the jawline, neck, chest, back, and forearms. To be specific, a dermatologist may diagnose melasma in six common locations:

• Brachial – This is when the patches appear on the shoulders and upper arms.
• Centrofacial – This is when the melasma affects most of the facial skin, including the forehead, nose, and upper lip.
• Lateral cheek pattern – This refers to pigmentation that appears on both sides of the cheeks.
• Malar – This refers to melasma that appears on both cheeks and the nose.
• Mandibular – This refers to the darker patches that are noticeable along the jawline.
• Neck – Melasma patches on the neck are more common among people who are aged 50 and older.

Melasma can be categorized into three main types depending on the depth of the pigmentation. During a skin consultation with a dermatologist, they can determine the type of melasma that you have with the help of a Wood’s lamp. Here are the three common classifications of melasma:

Epidermal Melasma

This form of melasma commonly appears on the superficial layers of the skin.  It usually develops a dark brown patch with a noticeably defined border. Under Wood’s lamp examination, epidermal melasma can be instantly visible on the skin. Since this is somewhat a milder form of melasma, it can clear up with proper treatment.

Dermal Melasma

Unlike epidermal melasma that forms on the top layer of the skin, this type of hyperpigmentation occurs due to the increase of pigment in the deeper layers of the dermis. They usually have a light brown or bluish color with a slightly blurred border. They will look the same under the black light and they may not be easily eliminated with treatment.

Mixed Melasma

As its name suggests, mixed melasma is a combination of dermal and epidermal hyperpigmentation. Its patches can appear brown to bluish on the skin. It will show a mixed pattern under Wood’s lamp and it can be improved with treatment.

It’s easy for dermatologists to diagnose melasma with a simple visual examination of the existing pigmentation on your skin. They may also use the Wood’s lamp to analyze the changes in the color of your skin and identify which type of melasma you have.

It can also reveal the extent of damage from sun exposure on the skin and determine the depth of pigmentation that’s not visible to the naked. This diagnosing technique can also help check if you have a bacterial or fungal infection that’s causing the pigmentation.

In more severe cases, a small sample of your skin may be removed for a biopsy. This test can help rule out other skin conditions that can also cause pigmentation issues. If you have thyroid problems, you may get it checked by your healthcare provider and see if it is affecting your melasma.

There’s no definite cure for melasma but there are treatments that can help lighten the patches and improve your skin appearance. Here are some of the treatments that reduce skin discoloration:

Chemical Peel

This popular cosmetic treatment can help remove the dead skin cells and take away the excess pigment for improved skin tone and texture. Chemical peels can help refresh your skin with healthier and new skin cells with lesser melanin. A light chemical peel can be effective for epidermal melasma, while medium-strength peels can help pigmentation in the dermal layers.

Topical Medications

Topical medications like hydroquinone and hydrocortisone can also help fade the discoloration caused by melasma. They can also improve the uneven skin tone and restore a brighter complexion.

Tretinoins and Retinols

These are prescription topical medications that are commonly used for sun damage, wrinkle, and acne treatment. They can be applied to the skin to boost the turnover of new cells and lighten the skin.

Kojic Acid

A doctor may also prescribe a 1% concentration of kojic acid to help clear the patches and improve the visible signs of sun damage, spots, and other lesions. It also has some anti-aging effects and can be used to brighten your skin.

Tranexamic Acid

This medication can come in topical or oral form, and it is usually recommended when other treatments don’t seem to work. Oral tranexamic acid can be taken twice a day to help improve melasma.

Melasma is a chronic condition so the patches can come and go, even after receiving treatment. Fortunately, most cases of melasma can respond to the medications and cosmetic procedures and they can fade away within months to a year after starting the treatment. Some patches can also go away on their own without treatment.

The best way to avoid skin damage and pigmentation is by having ample sun protection. When going out, make sure to wear sunscreen with an SPF of 30 or above and reapply them every 2 hours. You should also limit your trips to tanning salons and avoid too much exposure to UV light or radiation.

You should also change your skincare products and use gentler, fragrance-free cleansers and moisturizers. Avoid any cosmetic product that has an ingredient that may irritate your skin and worsen your melasma.