Melasma is a skin pigmentation disorder that primarily affects women, especially those with darker skin. It is commonly seen on the face and appears as dark spots and patches with jagged edges. Melasma is not physically harmful, but studies have shown that it can lead to psychological problems and a lower quality of life due to the changes it causes in a person’s appearance.
Melasma is a common disorder, with a prevalence of 1% and up to 50% in high-risk groups, including those with darker skin. Melasma is known as the “mask of pregnancy” because the hormonal changes caused by pregnancy, along with hormonal medications such as birth control pills, are the main triggers for excess production of skin pigment in melasma. Sun exposure is another major contributor to melasma.
Can melasma be prevented?
Currently, melasma cannot be fully prevented in people susceptible to developing this condition due to their genetics, skin color type, hormones, or level of sun exposure. Avoiding direct sun exposure during peak hours (10 a.m. to 4 p.m.), diligently using high SPF sunscreens, and avoiding hormonal medications when possible can help protect against melasma flare-ups and reduce their recurrence after treatment. Strict sun protection is the mainstay of any melasma treatment regimen.
What sunscreen should melasma patients use?
Choosing the right sunscreen is key if you develop melasma, and studies have shown that broad-spectrum tinted sunscreens, especially those containing iron oxide, can reduce pigment production in the skin. patients with melasma, as they block visible light as well as UVA/UVB. rays. Untinted sunscreens, on the other hand, do not block visible light.
For some people, it may be more convenient to use cosmetic products such as foundation that contain both UVA/UVB blockers and visible light blockers such as iron oxide. These products can conceal dark spots and therefore lessen the psychosocial impact of melasma, and at the same time act as a sunscreen to protect against darkening of the lesions.
It is important for people with melasma to know that visible light can pass through windows, and so even if they are not in the sun, they can still get melasma flare-ups from exposing themselves to visible light while driving or driving. sitting by a window.
Can melasma be treated?
Currently, there is no cure for melasma; however, there are several medications and procedures available to manage this condition. It is important to be aware that these treatment options may result in an incomplete response, which means some of the discolorations become lighter or disappear while others remain unchanged. In addition, frequent relapses are common.
It is also important to be aware of possible side effects of treatment, including darkening of the skin caused by treatment-induced inflammation, or further lightening of the skin in a treated area. Using the right medications under the supervision of a dermatologist can help achieve treatment goals and maintain them with fewer relapses.
Common treatments for melasma
The most commonly used treatments for melasma are skin lightening medications that are applied topically. These include drugs such as hydroquinone, azelaic acid, kojic acid, niacinamide, cysteamine, rucinol, and tranexamic acid. These drugs work by reducing pigment production and inflammation, and reducing excess blood vessels in the skin that contribute to melasma.
Pregnant women (who make up a large proportion of melasma patients) should avoid most of these medications, with the exception of azelaic acid, which is a safe choice during pregnancy. Hydroquinone is a commonly used skin lightener that should only be used for a limited time due to side effects that can occur with prolonged use. It can be used for up to six months for initial treatment, then occasionally if needed.
In most patients, combination therapy is required for the treatment of melasma. A common choice is the combination of hydroquinone with a retinoid that increases skin cell turnover and a steroid that decreases skin inflammation. Oral medications, including tranexamic acid, are usually considered for more severe cases of melasma. This medication is thought to help melasma by reducing pigment production and shrinking excess blood vessels in the skin.
Additional treatment procedures may help
If your melasma does not improve with topical or oral medications, adding procedures such as chemical peels and laser therapies to a treatment regimen might be beneficial.
Chemical peels use substances such as glycolic acid, alpha hydroxy acids, and salicylic acid to remove the surface layer of skin that contains excess pigment in patients with melasma. The effects of a chemical peel are temporary, as this procedure removes a layer of skin without reducing pigment production by regenerating the deeper layers.
Laser therapies can destroy pigment cells in the skin and therefore lighten dark spots from melasma. However, as with any other melasma treatment option, there is a considerable risk of relapse after treatment.
Maintenance therapy and prevention
After achieving improvement in melasma lesions, strict sun protection and maintenance treatment should be continued. Skin lighteners other than hydroquinone can be used in conjunction with retinoids to maintain results, and hydroquinone therapy can be used intermittently if needed.
Take-home message on melasma
The key point in managing melasma is to use sunscreen all the time and avoid other triggers such as hormonal medications when possible. Since none of the available treatments is a cure, prevention is the best option. People with melasma should see a board-certified dermatologist for proper evaluation and treatment regimens to manage melasma and maintain treatment results.
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