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Insights into the treatments for Melasma

Dr. Rashmi Sarkar busting some interesting facts related to Melasma and also highlights important treatment which should be done in case of Melasma

Published: Feb 23, 2021 03:26:20 PM IST
Updated: Feb 24, 2021 04:46:51 PM IST

Insights into the treatments for Melasma
What is Melasma?   

Melasma is a pigmentary disorder of the skin which appears as brown patches on the face of adults. Both sides of the face, especially the cheeks, bridge of nose, forehead, and upper lip, are involved. Some patients may have mild involvement in just a few of the above areas. This condition is very common, particularly those with darker skin types. Melasma is sometimes referred to as the mask of pregnancy, because it is sometimes triggered by an increase in hormones in pregnant women.

What are the causes of Melasma?     

The cause of melasma is complex; it has been proposed to be a photoageing disorder in genetically predisposed individuals. The pigmentation ultimately results from the overproduction of melanin by melanocytes (pigment cells); either taken up by keratinocytes (epidermal melanosis) and/or deposited in the dermis (dermal melanosis, melanophages).  

Hormones (including hormonal medications).

Fluctuations in certain hormones can cause melasma, which is why it commonly occurs during pregnancy. Melasma may also occur when you either start or stop hormonal contraception, including birth control pills, or when you take hormone replacement therapy.

Sun exposure.

The sun is the big culprit in triggering melasma. Melasma can be caused or worsened by not only the sun's rays, but also heat and visible light. This means that even sunscreens that protect against skin cancer aren't enough to ward off melasma. This makes treating melasma a challenge, particularly in the summer months.

Medications and scented products

New targeted therapies for cancer and perfumed soaps, toiletries, and cosmetics may cause a phototoxic reaction to trigger melasma

Issued in Public Interest by Oaknet Healthcare

What are the treatments for Melasma?     

The treatments for Melasma 

  • Laser Resurfacing: Laser resurfacing is designed to reduce wrinkles, scars, and most importantly for melasma patients, irregular skin discolorations. Using a non-ablative or ablative laser, layers of skin are removed to help the brown patches fade away. This procedure is delicate as the nature of using the laser to not only do away with the skin discoloration but also that the resulting skin tone is uniform with the rest of the face.  
  • Light Therapy: While UV light is a trigger for melasma, it may seem counterproductive to combat the effects of solar damage with light therapy. This option uses LED light to enhance the condition of the skin while eliminating minor skin flaws. However, LED light therapy is designed to be a supplement to other more aggressive cosmetic skin treatments and not a standalone remedy by itself. Yellow light is one of the newer options and is being used specifically for melasma as well as other similar conditions. Red light is also an option to consider with this therapy. 
  • Chemical Peels: Chemical peels work to exfoliate and peel away layers of damaged and overly pigmented skin. There are varying depths of peels to achieve desired results. 
  • Microdermabrasion and Dermabrasion: These techniques are reported to help treat brown spots and uneven pigmentation on outer layers of the skin. The main goal is to stimulate cell regeneration to combat the dark spots by removing layers of the skin through aggressive exfoliation. Dermabrasion is much more invasive than microdermabrasion, which tends to offer less dramatic results—especially in the treatment for melasma.  
  • Hydroquinone: This medicine is a common first treatment for melasma. It is applied to the skin and works by lightening the skin.  
  • Tretinoin and corticosteroids: To enhance skin lightening, dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains three medicines (hydroquinone, tretinoin, and a corticosteroid) in one cream. This is often called a triple cream.  
  • Topical medications used for the treatment of melasma include salicylic acid, tranexamic acid, glycolic acid, azelaic acid or kojic acid, arbutin, and ascorbic acid—which have all been known to lighten skin patches and symptoms of melasma.
What are the different types of Melasma?  

Depending on the level of increased melanin in the skin. Melasma can be separated into epidermal, dermal, and mixed types   

Epidermal melasma is defined by:

  • Border: well-defined
  • Colour: dark brown
  • Wood lamp: appears more obvious
  • Dermoscopy: Scattered islands of brown reticular network with dark fine granules
  • Treatment: usually has a good response.
Dermal melasma is defined by:

  • Border: ill-defined
  • Colour: Light brown to blue-grey
  • Wood lamp: no accentuation
  • Dermoscopy: reticuloglobular pattern, telangiectasia, arciform structures
  • Treatment: usually has a poor response. 
Mixed melasma is the most common type, and is defined by:

  • Combination of blue-grey, light and dark brown colours
  • Mixed patterns seen with Wood lamp and dermatoscope
  • Treatment usually shows a partial improvement.
Myths about Melasma 

  • Only pregnant women get melasma: melasma can affect men and women of all ages, in all stages of life.
  • Melasma goes away on its own: Unfortunately, you’ll need to treat your melasma with care it doesn’t tend to go away of its own.
  • You can’t reduce the appearance of melasma: There are plenty of treatment options that can help reduce melasma patches.
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