Melasma is a term derived from the Greek word ‘melas’ meaning black. It manifests itself as blotchy, irregularly patterned brown or sometimes even grey-brown hypermelanosis of the face, including nose, upper lip, and chin, as well as, on occasion, the neck. It is more common in persons of Hispanic, Oreintal and Indo-Chinese origin and Women are more often affected than men.
Melasma is divided into four distinct types:
• Epidermal (increased melanin in the epidermis): it is the most common and treatable form.
• Dermal: it is less responsive to conventional therapies and characterized by melanin-laden macrophages mainly in the dermis.
• Mixed epidermal-dermal
• Indeterminate type: found in patients with dark brown skin and in patients with deeply pigmented brown to darkest brown skin.
Contributing factors to melisma include exposure to ultraviolet light, genetic predisposition, pregnancy, use of oral contraceptives, and endocrine dysfunction or hormone treatments. Cosmetics and drugs containing phototoxic agents (e.g. anti-seizure medications) have also been linked to melisma. The release of melanocyte-stimulating hormone, which can be influenced by stress, suggests that melasma can be stressed-induced in some cases.
Melasma is often a challenging disorder for the dermatologist to treat. Therapies have included hypo pigmenting phenolic and non-phenolic derivatives, chemical peels, intense pulsed light and laser therapy. Topical treatments may temporarily improve the skin, but the condition often returns. The main type of therapy include protection from sunlight, inhibition of the activity of melanocytes, inhibition of the synthesis of melanin, disruption of melanin granules, and removal of melanin.
Protection from sunlight
Sunscreen, also known as sun cream, is a lotion, spray, gel or other topical product that absorbs or reflects some of the sun's ultraviolet (UV) radiation and thus helps protect against sunburn. Sunscreens with both UV and VL protection could be useful in this condition. Sunscreens in the VL range usually contain absorbing pigments such as iron oxides
Various systemic agents with protective action against UV spectrum, such as chloroquine, indomethacin, vitamin C, and E, β-carotene, fish oil, and green tea are available for use.
Other sun protection tools
These include use of an umbrella, wearing a hat, seeking shade and avoiding peak UVR exposure time.
Skin lightening creams
Certain chemicals can reduce the activity of pigment-forming cells in the skin, and of these, hydroquinone is the most commonly used. Hydroquinone creams may cause irritation, and care must be taken to ensure that they are not used for too long in case they cause excessive skin lightening. Hydroquinone can occasionally cause increased darkening of the skin, especially in dark-skinned people. Hydroquinone creams can now only be prescribed by doctors. Azelaic acid and retinoid creams that are used to treat acne can also help melasma. All these creams can irritate the skin and are therefore sometimes combined with steroid creams. Some skin bleaching creams contain a mixture of these ingredients.
Chemical Peels, Micro-Dermabrasion and Laser-treatment
Dr Ayham Al-Ayoubi: Chemical peels can improve melasma by removing the outermost cells of the skin that contain the excess pigment. These techniques should be undertaken by an experienced practitioner as they have the potential to make the pigmentation worse, to lighten the skin too much or to cause scarring. Some types of laser also remove the outer layer of skin, whereas others specifically target the pigment-producing cells. At present, the success of laser treatment is variable, and the possible side effects can be similar to peels and micro-dermabrasion as mentioned above.
Skin camouflage is a highly pigmented crème which is matched to individual skin colour and is relatively difficult to remove. Self care The most important thing for patients to do if they have melasma is to protect the skin from sunlight exposure. It is also important to avoid the use of sunbeds.
If melasma improves, sustained improvement can be achieved by continuing to protect the skin from the sun.
To read more about Chemical Peels click here.