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Melasma Should Not Be Overlooked

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Many patients ask me questions like, “I have dark patches on my cheeks and they’re getting darker over time. What should I do?” Most patients know that what they have is melasma, so it is not surprising that they have tried all kinds of over-the-counter melasma products and creams that claim to cure melasma in no time, while others have even seen medical professionals. After their treatments, some patients said that the condition improved, while others reported that it actually got worse. However, in most of these cases, the patients tell me that their condition remained unchanged after treatment. Today I would like to talk about melasma, a condition that should not be overlooked.

Melasma, or chloasma, is a patchy light to dark brown or grayish discoloration found on sun-exposed areas of both sides of the face, such as the cheeks, forehead, temples, above the upper lip and nose. This condition occurs much more often in women than in men and is more common in the middle age group (30-40 years). Melasma is a form of hyperpigmentation, which is caused by an increase in the melanin produced by the pigment cells (melanocytes). Shallow melasma appears on the outer layer of the skin (epidermis) and is identified by its dark color with clearly seen edges. Deep melasma is found in dermis, and is usually lighter in color, often a purple/blue shade. It is also more difficult to discern the edges of deep melasma patches. Most patients have a combination of these two types of melasma.

Risk Factors for Developing Melasma

  • Sunlight is the greatest risk factor, resulting from exposure to UVA, UVB and Visible light.
  • Hormonal lead to the production of more melanin pigment, whether through pregnancy, menopause, oral contraceptives, or cosmetics containing hormones.
  • Genetics play a role in about 50% of cases of people affected by melasma.
  • Malnutrition may be a contributing factors because melasma is often found in people with abnormal liver function and vitamin B12 deficiency.
  • Cosmetics containing hydroquinone may cause dark patches, like melasma.

The above are the risk factors for developing melasma. Generally, shallow pigmentation can happen easily and locate the outer layer of skin so it is easier to treat than deep pigmentation. Try to avoid the risk factors to reduce the risk of developing the condition and reduce the risk of melasma reappearing after fading.

How to identify causes and avoid risk factors

  • In cases when sun exposure is your trigger, through long periods of working in the sun or playing outdoor sports, like golf or tennis, you can protect yourself by wearing a hat, using an umbrella or UV protection face mask, applying sunscreen of SPF 30 or higher, and avoiding direct sunlight especially between 10 am – 4 pm when the UV radiation is strongest.
  • In cases where the melasma is caused by hormonal changes resulting from pregnancy, the patches will fade gradually after the delivery in most cases. If the risk factor hormones are from external sources, such as taking contraceptives or using cosmetics containing hormones or placental extracts, consider changing your method of birth control to contraceptive coils/loops and condoms, and switch to cosmetics that do not contain hormones.

Treatment of Melasma

Topical Creams

There are so many creams on the market that claim to treat melasma. The creams that give faster results may carry an increased risk of side effects, while other creams may have little effect on the condition. Most of the creams on the market target the symptom of melasma—pigment in the skin—but not the primary cause of the condition—the skin cells that produce the pigments. As a result, even if the creams appear to ‘cure’ the condition, the melasma hyperpigmentation may return after discontinuing treatment with the cream.

Laser Rejuvenation

With the advent of laser technology, laser rejuvenation is an effective method of treating melasma. The HELIOS II laser can effectively treat melasma; freckles; uneven skin; tattoos in black, blue or green; pigmented lesions; birthmarks; and dark spots. Laser rejuvenation also stimulates the production of collagen in the face during the treatment.

Using laser treatment may seem like a frightening process to many people. However, HELIOS II is very safe. During the treatment, you may feel a mildly warmness on the skin and a tingly sensation on the pigmented area. However, this laser treatment does not break in the skin or have bleeding, it also helps to prevent any possible complications.

After the treatment, patients should follow the doctor’s advice by avoiding sunlight, applying moisturizer and wearing sunscreen of SPF 30 or higher.

Other Methods

Include chemical peeling, AHA peeling or microdermabrasion.

Melasma treatment is time-consuming. Prevention is definitely better than cure. Avoid direct sunlight between 10 am – 4 pm, and wear sunscreen regularly. However, if melasma occurs, talk to a dermatologist to get advice, identify the cause, and receive the most appropriate treatment.

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Anongluck Rattanasirivilai, M.D. Summary: Dermatology Dermatology