What Is The Best Way To Treat Melasma?

Treatment options for melasma include topical medications – lotions, creams and gels or medical procedures such as lasers, chemical peels and microneedling, sometimes even dermal fillers.

What causes melasma on face?

Melasma is a form of hyperpigmentation that primarily affects women and especially more so for those with darker skin. It is triggered by long term UV exposure as well as hormonal influences. Because of the multiple skin condition changes that has been there for quite a long period of time, that makes melasma tougher to treat.

Melasma is caused when there is over-production of the pigments (melanin). This is due to that the pigment cells (melanocytes) are being constantly triggered by the skin environment and the current skin condition. Skin that has basement membrane that is weakened by long term sun exposure, aging and surrounded by abnormal blood vessels  are prone to be irritated and overly-producing pigments, leading to melasma.

This skin condition is usually exacerbated by hormonal changes (pregnancy, taking birth control pills or hormone replacement therapy (HRT)). Incompatible product skincare could potentially trigger the development of melasma on the skin as well.

Endogenous hormones during pregnancy can stimulate the melanocytes into producing more melanin pigments. Taking birth control pills and undergoing hormone replacement therapy (HRT) causes imbalance the current hormone levels, so melanocytes are producing more melanin than it should. If any family members are diagnosed with melasma, there are chances that this skin condition might passed down to the other generations.

Signs and Symptoms

The symptom can usually be seen with naked eyes. Dark spots and uneven skin tones, followed by discoloured patches of skin at the upper lips, bridge of the nose, cheeks and forehead are all the signs needed to confirm the development of hyperpigmentation on the skin. In certain cases, such signs are obvious on arms and neck. At times, there are confusion if the symptoms of melasma are related to other skin conditions. Talk to your aesthetic doctors or dermatologists if you have any doubts.

Can you get rid of Melasma?

The causes of melasma is complex and involved many structural changes¹. There are ways that melasma can be reduced but it is known to reoccur even after a successful treatment, if the root cause is not being tackled. The typical basic treatment is via topical medication with arbutin or hydroquinone. For better treatment of melasma, lasers, peels, oral medication and basement membrane restoration has to be taken into account. The success of treatment is highly dependent on individuals. In short, not all treatments work for everyone and there is no guarantee of 100% success.

Restoration

Restoration of the skin health is the most important step in managing melasma. Therefore repairing the basement membrane, and restoring the basement membrane function using devices such as Sylfirm or Sylfirm X is very crucial. Without these steps, many people with melasma will have rebound cases or worsening of the melasma after years of using lasers or creams.

Removal

This treatment is via laser therapy, intense pulse light or chemical peel and has been proven to help treat melasma. Potential side effects may include inflammation, irritation and a burning sensation.

Laser therapies (Picogenesis, PicoSure, Q-Switched, Aerolase, Glacier Rx) 

Laser treatments are more precise than chemical peels. In laser therapies, high-energy lights are used to target the affected area as it removes hyper-pigmented skins cells at the surface or deeper level, depending on condition severity. In the new era, good quality picosecond laser with very mild energy is important to help clearing the melasma without causes long term side effects. Also the use of ccooling technology such as with Glacier Rx will be helpful in the long term treatments of melasma.

Chemical peels

Glycolic acid (AHA) is used frequently by aesthetic doctors and dermatologists for chemical peeling. It induces the top layer of the skin to peel off and increase the skin cells turnover. As the skin sheds, new, unblemished skin will be revealed. This is only effective in mild and not complicated melasma. It should not be used in darker skin types, especially in tropical countries.

To regulate skin colouration, here are the few ingredients typically present in topical medical or skincare products to treat melasma.

Can oral creams treat melasma?

To prevent further hyperpigmentation, it is recommended to use a broad-spectrum sunscreen with a high SPF in our daily skin-care routine.

Conclusion/ Final Thoughts

In conclusion, melasma can be treated effectively but there is no guarantee of success despite the numerous procedures available currently. It is advisable to consult with an experienced medical aesthetician to set expectations right. The same procedure may product different results for different individuals so it is best to have a tailored program and to monitor your progress closely with your attending aesthetic doctor.

References
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