How Can I fix the Melasma On My Face?
Melasma is a complicated condition that requires us to nip it at its bud1. There are treatments that can bring solution to the matter but without treating the root cause, the condition will come back or worsen with time. In the case of melasma, just like any other medical condition, prevention is easier and way better than cure.
Understanding Skin Biology and Melasma
There are two main layers of skin which are the epidermis (surface) and dermis (deeper). In between is a layer of cells regulating the growth and the health of the skin and it is called basement membrane or basal cell layer. It continuously dividing to produce hydrated new skin cells (millions daily). The top layer of epidermis is called stratum corneum or “horny layer”. This is the part of layer that we can see from the outside through our naked eyes. These cells are dead, contain a lot of keratin, being arranged in overlapping layers that gives out a tough waterproof character to the skin’s surface. Dead skin cells are shed daily as the new cells are formed to make it balance. As we are exposed to sunlight, the darker the colour of our skin. This is due to the pigment cells (melanocytes) in the epidermal layer near the basement membrane being stimulated to protect the skin.
The dermis (deeper) contains collagen and elastin to bring elasticity and strength to the skin2. When the skin becomes older, the fibroblasts in the dermis produces lesser collagen causing the pigment cells to be easily irritated leading to higher chances of getting melasma.
What can increase the risks of Melasma?
There are several factors that increases the risks of melasma: long period of sun exposure, habit of sun tanning, stress, iron deficiency, hormonal imbalance are a few of the factors that relate to the risks of developing melasma.
Sun exposure and melasma?
UV radiation causes development of radicals that can cause disruption in the structures of the skin. It breaks down the collagen as well as weakens our basement membrane of the skin. When the basement membrane is weakened, it is easily irritated. That is why many people who has weakened basement membrane tends to has skin that is easily flushed and red. Many people regarded that as skin being thinned. The skin is not thinned but just easily inflammed due to the building up of abnormal blood vessels.
Why stress can cause melasma?
Stress increases stress hormones and also triggers the over-production of pigments by the pigment cells. As the over-production occurs, brown patches are slowly forming to the surface of the skin area. Therefore it is important that one should take into account adequate sleep, stress management as well as reducing body stress as a good way to prevent melasma.
How can facial melasma be treated?
There are two ways for melasma to be treated; removal of the discoloured skin or regulation of the pigment.
Removal process can be done through chemical peel, laser therapy, or cooling technology. Knowing the right treatment will be able to get rid of the melasma effectively, but if the root cause is not treated, there are chances for the melasma to come back again.
The most common substance that are being put to good use is Glycolic acid (AHA). Chemical solutions that soften and exfoliate the affected skin of the patient is applied. After a while, the surface of skin peels off as the unblemished new skin underneath appears. Chemical peels are easier to use in lighter skin types and in climated countries. Normally, it is not advisable to treat darker skin types with chemical peels, and chances of complications and rebound are so much more higher in tropical countries.
Laser therapies (Fraxel, Erbium YAG, CO2 lasers, Q-switched laser, Picosecond laser) and Intense Pulse Light (IPL)
The use of laser therapy and intense pulse light are clinically proved to be effective than chemical peels in term of treating melasma. It is more precise in deleting the hyperpigmented skin cells at the surface level and deeper, but it really depends on the severity of the symptom. However, Intense Pulse Light is less favourable in tropical countries due to long term ineffectiveness and complications. Ablative and semi ablative lasers were at one time popular treatments for melasma but went out of fashion due to their long term complications. A lot of people have worsening melasma after being treated with the “burning off lasers”. Picosecond lasers became more favourable these days due to the long term safety. However, not all Picosecond lasers are the same. Only picosecond lasers with stable energy output will have good results in the long run. Picosecond laser treatment result is also highly dependent on the doctor who treats it as well.
The other very important component of treating melasma on the skin is to use to regulate the pigment cells in the skin. To regulate the pigment cells effectively, the basement membrane has to be treated and restored to its healthier form. Sylfirm and Sylfirm X are devices that is used to treat basement membrane of the skin effectively. On top of that, taking oral tranexamic acid and applying proper skin care is also important.
The Right Skin Care
Keeping the skin hydrated in the right amount is very importnat. Over hydrating and under hydrating can be equally devastating. Usage of hydroquinone is very popular at one time but it can irritate the skin and cause more problem. Skin care that contains arbutin, kojic acid, niacinamide are used these days to help control the pigmentation of the skin.
Broad-spectrum sunscreen with high SPF can be applied in daily skin routine in order to fight the melasma. It does take more time for the result to show the sign of effectiveness.
Conclusion/ Final Thoughts
In conclusion, there are ways to reduce the melasma and to get it treated accordingly whether through professional treatment or an effective usage of skincare. The problem of brown patches appearing is no longer be an issue.
1. A review of combined treatments for melasma involving energy-based devices and proposed pathogenesis-oriented combinations. Joseph N. Mehrabi, Efrat Bar-Ilan MD, Shehadeh Wasim MD, Amir Koren MD, Lior Zusmanovitch MD, Fares Salameh MD, Gila Isman Nelkenbaum MD, Tamir Horovitz MD, Eyal Zur RPh, Ting Song Lim MD, Jacob Mashiah MD, Ofir Artzi MD. J Cosmet Dermatol. https://doi.org/10.1111/jocd.14110
2. Goldie K, Kerscher M, Fabi SG, Hirano C, Landau M, Lim TS, Woolery-Lloyd H, Mariwalla K, Park JY, Yutskovskaya Y. Skin Quality – A Holistic 360° View: Consensus Results. Clin Cosmet Investig Dermatol. 2021;14:643-654