#AskDrGina – Melasma
Our first post in the #AskDrGina series covers a topic we’re asked about a LOT. Melasma is a skin condition most common in women, causing patchy discolouration of the skin, usually on the face – however, it can also occur on the neck and forearms.
While it’s not dangerous, it can reduce your confidence in going bare-faced and unfortunately, there is no quick fix. Below, Dr. Gina explains the condition and her treatment and management recommendations for Melasma.
Ocean Cosmetics: We hear it all the time, “What are these dark, blotchy patches on my face?” Can you shed some light, Dr. Gina?
Dr. Gina Messiha: Melasma is a common hyperpigmentation disorder that can cause dark, blotchy patches of discoloured skin, usually on your face. It is more common in women with darker skin tones and can be intensified during pregnancy (referred to chloasma or ‘mask of pregnancy’). While Melasma has no adverse effect on health, women often feel self-conscious about the skin-discolouration.
OC: What causes Melasma?
GM: The exact cause of Melasma is not yet fully understood. Estrogen and progesterone sensitivity are associated with the condition, so hormone replacement therapy (HRT), oral contraception and pregnancy can be a trigger. Some people may also have a genetic predisposition to the condition.
Additionally, sun exposure can cause melasma because ultraviolet rays affect the cells that control pigment (melanocytes).
OC: Can you cure Melasma permanently?
GM: Unfortunately, Melasma is a chronic, reoccurring condition with no quick fix. While we might not be able to completely cure or resolve the condition, we work closely with you to help you manage and improve it.
I believe it is important to spend time educating my patients about the nature of Melasma rather than offer a treatment that may provide temporary improvement or potentially make the condition worse.
The Fraxel laser was the first FDA approved laser to treat Melasma. When this first launched I got really excited thinking we’d found a magic wand to treat this frustrating skin condition. Unfortunately, the outcomes were not as successful as we had hoped, and in some cases, the pigment got worse. While some patients saw a short term improvement, the condition reoccurred and in some cases, there was no improvement at all.
OC: What do you recommend for treating or managing Melasma?
GM: This is what I recommend to my patients, to help manage and improve the appearance of Melasma. It is important to note that all procedures carry the risk of hyperpigmentation and a high risk of recurrence if you’re not committed to following the long-term regime.
Here’s my preferred treatment plan for Melasma. Please note this is general information only, and every treatment plan should be created based on individual needs following a no-obligation consultation with your doctor.
- Slip slop slap– Use a broad spectrum sunscreen with a minimum SPF 30+ with a physical block such a wide brim hat. Sunblock has to be applied every day regardless of your planned activities. There is no sunblock in the market which does not require reapplication every 4 hours, minimum. BB cream which includes SPF30 can be added on top of the sunblock.
- Topical bleach– As much as it pains me to say this, in my experience, the mainstay for Melasma treatment is topical bleach. Hydroquinone is the most potent, however other natural bleachers include Azelaic acid, Retinoids, Vitamin C, Vitamin B3, Kojic acid, Arbutin, and Liquorice extract. Hydroquinone blocks a critical step in the formation of melanin and lightens the skin essentially by bleaching the pigment where it is applied. I usually put my patients on a pulse therapy of hydroquinone, supplementing the treatment with vitamin B3, which is crucial for improving the skin barrier and reducing irritation. I also recommend Vitamin C, sunblock, Azelic or Salicylic Acid, and Retinol all the time. Retinol is essentially a derivative of Vitamin A, one of the body’s key nutrients for boosting cell turnover. In the treatment of Melasma, it decreases the number of melanocytes (the cells that make pigment and cause skin darkening), while also increasing penetration of other products.
- Professional skin treatments– This is an option we will explore only after I have seen significant improvement in the condition with home care. Once we start seeing that improvement, we will create a cosmetic grade treatment plan. This plan will often consist of; low concentration superficial lactic, salicylic, glycolic and TCA peels; microdermabrasion; low fluence 1064 Nd:Yag Q switch to laser and broadband light. It’s hard to say which treatment will be suitable for your skin because every case is different.
OC: What should I do if I suspect I have Melasma?
GM: If you have noticed dark, patchy areas of discoloured skin on your face, neck or forearms, I recommend you consult a healthcare professional that specialises in treating skin disorders. They will be able to make the correct diagnosis and put together a treatment plan that is best suited to you.
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