What is Melasma
Melasma (also known as chloasma or ‘mask of pregnancy’) is a dark skin discoloration that appears on sun-exposed areas of the face, most commonly the cheeks, forehead, nose, or upper lip. Melasma is a common skin condition, and can affect women and men of all ages and races, but is most often seen in women with olive to darker skin tones. While melasma does not cause any medical symptoms other than skin discolouration, it can cause distress on a cosmetic level, and affect self confidence.
Melasma is stimulated by oestrogen – either from pregnancy, the pill, hormone replacement therapy or normal circulating oestrogens, and is a difficult form of pigmentation to treat. Sun exposure is the other strong risk factor for melasma. While melasma can never really be ‘cured’, it can be managed and treated to minimise its effects and recurrence.
A doctor will usually be able to diagnose melasma based on the appearance of the skin. They may if necessary, use a Wood’s lamp, which uses an ultraviolet light, to closely examine at the skin.
Simple Steps to Take
It is important to try to determine if there are any causative factors that may be exacerbating the pigmentation, for example, the oral contraceptive pill.
The next step is daily UV protection and avoidance, and this is paramount in the treatment of melasma. UV radiation is a key factor that exacerbates melasma, and often those affected with melasma first notice it appearing during or after the summer months. Using an SPF 30+ sunscreen on a daily basis is very important. Wearing a wide brimmed hat during peak UV periods during the middle of the day is also important.
Treatments For Melasma
- A topical lightening agent such as the enRich Lumina Cream or enRich Bleaching Cream can to used to help lighten melasma. These creams contain a powerful combination of lightening and exfoliating agents to help lighten skin pigmentation. In particular, 4% hydroquinone, contained in the creams, helps to prevent the production of new melanin (skin pigment), while retinoic acid (in the Lumina cream) and salicylic and ascorbic acid (in the Bleaching cream) help to gently exfoliate skin.
- The new Fractional Ruby Laser is the laser treatment of choice in melasma. Gentle treatments at low energy levels are done at weekly intervals, for several weeks, combined with depigmenting creams and sun protection. This regimen greatly reduces the risk of post-inflammatory hyperpigmentation, which the main potential side effect when treating melasma. The Fractional Ruby Laser wavelengths are targeted to attract the pigmentation in melasma, compared to the surrounding normal skin. This laser is ideal for the treatment of melasma as it allows for the use of very low energy levels, and short pulses of energy. As the name suggests, the laser is ‘fractional’, meaning that it only treats a fraction of the skin by firing micro-columns of laser energy into the skin, thereby treating only a portion of the skin in a given area, while still preserving the normal healthy skin between these spots. This preservation of healthy skin results in faster healing following the laser treatment. The downtime is minimal (usually only mild redness for a day). Generally, most people return back to work the next day.
- The Fraxel Dual laser (1927 wavelength) is another option for the treatment of melasma. It has FDA (Food and Drug Administration) approval for the treatment of melasma in the US. However in general, this option is not as useful for the treatment of melasma, particularly in darker or olive skinned individuals.
- Chemical peels can help speed the process of improvement from melasma by helping with skin turnover. Usually light chemical peels are used, as stronger chemical peels can often stimulate new pigmentation production.
What Is The Longer Term Course Of Melasma
As a note of caution, it is important to note that melasma is a chronic skin condition, and cannot be ‘cured’, as such. It has a tendency to recur with preganacy, the use of the pill, or with sun exposure. It requires ongoing management and vigilance against sun exposure.