Melasma: Understanding and Treating Hyperpigmentation

Melasma causes dark, discoloured patches, often on the face. It’s more common in women and can be triggered by hormonal changes, sun exposure, and genetics. Effective treatment typically involves a combination of at-home care and in-clinic solutions.

What Causes Melasma?

Melasma is driven by hyperactive melanocytes that produce excess melanin. Contributing factors include:

• Hormonal Fluctuations: Pregnancy, contraceptives, and hormone therapies can trigger melanin production.

• UV and Visible Light Exposure: Sun exposure can worsen melasma, making consistent protection crucial.

• Genetics: Family history can increase susceptibility.

Treatment Options for Melasma

A comprehensive strategy combining topical therapies and in-office procedures is often the most effective.

Topical Treatments

1. Hydroquinone: Widely regarded as the gold standard, hydroquinone inhibits melanin production. Prescription-strength options are available, however, need discussion with your doctor. T

2. here are also over-the-counter (OTC) formulations like Superfade, which contains 2% hydroquinone, offering a milder option for lightening dark spots. JCAD found 4% hydroquinone reduced melasma by 75% after 12 weeks (2020).

3. Retinoids & Retinoic Acid (Tretinoin): Retinoids boost skin turnover, helping fade dark spots. Retinoic acid is a stronger form, improving the effects.

4. Azelaic Acid: An anti-inflammatory that lightens dark spots by inhibiting tyrosinase.

5. Arbutin (Alpha & Beta): A natural derivative that reduces melanin formation. Alpha-arbutin is known for its stable, potent depigmenting effect.

6. Kojic Acid (0.1-1.8%): Extracted from fungi, kojic acid helps lighten skin and is often used in conjunction with other treatments to enhance results.

7. Ascorbic Acid (Vitamin C): Potent antioxidant that brightens skin and reduces pigmentation. Effective concentrations range from 1% to 20%. It also boosts collagen production.

8. Cystemine: An emerging pigment inhibitor from Europe that shows promise in managing melasma, helping to lighten skin without major irritation.

9. Licorice Root Extract: Contains glabridin, which helps inhibit tyrosinase, the enzyme responsible for melanin production. Known for its soothing and brightening effects.

10. Alpha Hydroxy Acids (AHAs):

    • Glycolic & Lactic Acids: Exfoliate the top layer of skin, helping to fade pigmentation.

    • Citric Acid: Another AHA that gently exfoliates and brightens skin.

11. Tranexamic Acid: Topical preparations are available and have variable success in reducing melasma pigmentation effectively (JDD, 2021). Oral preparations are available, however they have risks and are provided on consultation with a specialist dermatologist.

In-Office Treatments

For persistent melasma, professional treatments can enhance outcomes:

1. Chemical Peels: Glycolic or salicylic acid peels can exfoliate pigmented cells. Research showed that glycolic peels improved melasma significantly without major side effects (IJD, 2020).

2. Laser Therapy for Melasma: Laser treatments can be highly effective for targeting melasma, but they must be chosen carefully to avoid worsening the condition. Key types includ Q-switched ND, Picosecond lasers, fractional lasers and non-ablative lasers. I do not offer laser service, however, I can link you in with trusted practitioners to discuss your individual suitability.

What to Avoid

To manage melasma effectively, it is crucial to avoid:

• Excessive Sun Exposure: UV rays worsen melasma. Always use a broad-spectrum sunscreen and seek shade, especially during peak hours.

• Heat Exposure: Heat, not just sunlight, can increase pigmentation. Avoid prolonged exposure to saunas, hot showers, or direct heat sources.

• Irritating Skincare: Harsh scrubs or products with alcohol can aggravate melasma. Opt for gentle, non-comedogenic skincare.

• Hormonal Triggers: Where possible, consult with a healthcare provider to evaluate any hormonal treatments that might be contributing to pigmentation.

The Role of Sun Protection

Daily use of broad-spectrum sunscreen with at least SPF 50 is critical. Sunscreens with iron oxide can also block visible light, which contributes to pigmentation. Research highlighted that consistent sunscreen use significantly reduces melasma recurrence (PPM, 2020).

Conclusion: A Personalised Approach is Key

Treating melasma effectively requires a combination of topical agents, professional treatments, and rigorous sun protection. Each case should be assessed individually to tailor the most effective plan. Consulting with a skin specialist ensures the best outcomes.

References:

1. The Journal of Clinical and Aesthetic Dermatology, 2020.

2. The American Journal of Clinical Dermatology, 2021.

3. Dermatologic Therapy, 2019.

4. The Journal of Drugs in Dermatology, 2021.

5. International Journal of Dermatology, 2020.

6. Dermatologic Surgery, 2020.

7. The Journal of the American Academy of Dermatology, 2021.

8. Photodermatology, Photoimmunology & Photomedicine, 2020.