Melasma is a dynamic and chronic pigmentary disorder that is more common in women then in men although there are men with the condition. It is often also known as hormonal pigmentation , the mask of pregnancy or chloasma. An important aspect to note is that it is chronic and requires lifelong and holistic management. Melasma can be found in the dermis ( middle layer and much more difficult to treat) as well as the epidermis (the top layer where the pigment is actually produced.
It appears on the cheeks , forehead , upper lip , bridge of the nose but can also appear on the forearms , neck and upper back.
It is more apparent in darker skin types but appears in all skin types. Even though it is hormonally mediated (possible unopposed oestrogen) there are factors that make it worse.
Exposure to UV light and now in our modern world exposure to high levels of pollution lead to a phenomenon called atmospheric aging and inflammation . UVA rays are a stimulant for melanin to develop on the skin, and unfortunately can even penetrate through windows, (I often find that because of driving the pigmentation on your right may be worse than the left side of your face).
Infra Red Light also emitted from the sun is another factor that causes inflammation of the melanocyte and causes it to produce and release pigment into the skin.
High Energy Visible light has also been found to be a perpetrator. This type of light is emitted from phone screens, TVs, computer screens and fluorescent lights . This is why traditional sunscreens, even with religious use , falls short in terms of offering full protection.
Heat ( from steam rooms ) and stress can also cause inflammation in the melanocyte and it releases melanin as a protection mechanism.
How would we treat and combat this chronic Melasma? My approach is holistic – calming the melanocyte with creams and supplements, protection against UV and other light and also removing the pigmentation already present with homecare and professional in-office treatments.
Anti-oxidants supplements that contain N-acetyl-cysteine, Alpha Lipoic Acid and Pycnogenol help decrease inflammation and assist your body in making its own Glutathione . My favourites are Yllume and Ovelle. Other options include Glutathione gels , IV infusions and and transdermal patches. This is treating the Melasma internally.
Creams that contain arbutin, Hydroquinone, Tretinoin, Retinol, Vitamin C, Phytic Acid, Salicylic Acid, and Kojic Acid are great choice for reducing melanin production. I often use Dermaceutic Dermabase (with prescription ingredients) or the Dermaceutic Yellow Cream or Dermaceutic Mela cream as potent at-home treatments to treat the melasma as well prepare patients for in-office treatments. If we down-regulate melanin production the incidence of post-inflammatory hyperpigmentation from in-office treatments is reduced. The Dermaceutic Activ Retinol Serum can be used in conjunction with these potent depigmenting creams . Dermaceutic Lightceutic is another firm favourite amongst patients – general skin brightening and the glycolic acid provides mild exfoliation to rid the skin of pigmented keratinocytes. The vitamin C provides anti-oxidant action.
It is important to take it slow with these very active products and not abuse them. Also important to remember is that they are for night time use and while using them to be hypervigilant with Sun and Anti-oxidant Protection.
Another favourite of mine is the Dermaceutic Trivita C30 with Ferulic acid. I often recommend this to patients that travel to the city for work, work with computers and in harsh lightening. This is an anti-oxidant super bomb that protects against atmospheric aging and inflammation. This works well under Dermaceutic Sunceutic and Dermaceutic Kceutic.
Once your skin is prepared correctly and ready to receive treatments we start with the Mela Peel and now I am pleased to say another great innovation called Mela Peel Forte for very stubborn Melasma. Mela Peel Forte also contains Resorcinol, which as a bonus “side-effect” reduces acne. The bonus with these two peels is that they are safe for darker skin types and besides treating melasma can also be used off-label for acne.
It is important to remember that as a chronic condition Melasma can return post-treatment . It takes time and consistency to see results from a treatment programme.