Melasma is a common pigmentation condition recognized by dark patches on face and skin. The word melasma is translated to “black spot”. This condition is more common in women than men with pregnancy being the cause of the condition hence, it is known as the “mask of pregnancy’.

Here, the good part is that there is efficient melasma treatment which helps in identifying root causes of hyperpigmentation melasma and how to treat uneven skin tones.

What is Melasma?

Melasma is a skin disorder that causes brown or greyish-brown patches on the face, If you have melasma dark patches on the face or skin may appear out of the blue. These patches might be flat or may appear like freckles. Commonly affected areas include black patches on the face, including cheeks, lips, forehead, and even forearms but melasma can affect any part of the skin exposed to sunlight. Melasma is commonly found in people with darker skin, occurring mostly in people with light brown skin types.

Even though melasma pigmentation darkens and lightens periodically, sometimes it gets worse in the summer and better in the winter. Often, melasma goes away on its own. This happens when the trigger which causes melasma is no longer present, like in pregnancy melasma is a common condition so it may disappear once the baby is delivered. On the contrary, it can last for years or even a lifetime. While melasma medication like creams can help in reducing the appearance, the condition can occur again.

Melasma is also known as chloasma. This condition is considered harmless, but melasma on the face and other regions might make people self-conscious.

Causes and Triggers

Even though there hasn’t been enough research that points as to why melasma exactly happens, It is discovered that when someone is suffering from melasma, it’s the cells that give pigmentation to the skin known as melanocytes are more active. This might happen when something triggers the melanocytes which in turn makes them produce more pigmentation.

There is a list of possible melasma causes and triggers:

• Radiation: When ultraviolet, visible light or infrared (heat) light such as sunlight hits the skin, it produces more melanin. That is why melasma skin most includes regions exposed more to sunlight like skin on the face, neck, and arms. Forms of radiation may even include LED Screens and Tanning beds.
• Hormones: Hormones such as estrogen and progesterone when in high levels trigger melasma. These hormones mostly increase during pregnancy. Oral contraceptive pills also contain estrogen and progesterone and cause a rise in the hormones, Diethylstilbestrol is a form of the hormone estrogen used in treatments for prostate cancer. All these may trigger hyperpigmentation melasma.
• Medications: Seizure-preventing drugs such as Clobazam may be a cause of melasma. Phototoxic drugs are medicines that cause sensitivity to sunlight like antibiotics, and nonsteroidal anti-inflammatory drugs that cause melasma.
• Hereditary: Many people including the population with a majority of 33% to 50% with melasma have reported the existence of the condition in their family, also it is discovered that identical twins both have melasma.
• Cosmetics: Some cosmetics or skin care like retinoids and soaps can cause a phototoxic reaction which can worsen melasma.

Understanding Melasma’s Impact on Skin

Some people have a higher risk of melasma if the are

• Female between the ages of 20 and 40, since it is 9 times more common in women than men.
• Having a medium or dark skin tone
• Or blood relative of a person having melasma

Hyperpigmentation mostly has three types:

• Post-inflammatory hyperpigmentation
• Age spots
• Melasma

The three are separated by the distinct root causes and ways of treatment. Melasma’s appearance mostly includes pigmented patches in a butterfly pattern on the cheeks and forehead. People with dry skin or are suffering from eczema may develop worse symptoms than those with oily or combination skin since their skin barrier is damaged.

Identifying Melasma

Signs and Symptoms

Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. Sometimes the patches can become red or inflamed.

Signs of melasma may include the following:

• Melasma spots are darker than natural skin colour
• The spots caused by melasma appear on both sides of the face
• They can cover a large area of the face and can be more noticeable in some areas of the face, for example, black patches on cheeks.
• The more time the skin is exposed the skin, the condition appears to worsen.

How Melasma Differs from Other Skin Conditions

The main difference between melasma and other skin conditions such as hyperpigmentation is the cause of the condition, melasma’s prime cause is hormones and it worsens with sunlight. However, hyperpigmentation can be caused by sun exposure, inflammation, acne, or skin injuries.

Also, the spots caused by melasma are symmetrical, with distinct borders but the patterns due to hyperpigmentation are uneven and can appear as linear streaks, uneven patches, or isolated places. Melasma is trickier to treat since it is related to hormonal-related causes, however, hyperpigmentation may be treated with treatments such as exploration, chemical peels, or laser therapy.

When to Consult a Dermatologist

If you notice the uneven colour on your face appearing slowly over weeks or months and spots which appear flat, you should consult your dermatologist.

A dermatologist uses a specialized device known as Wood’s lamp or dermatoscope to see how deep the darker pigments are into the layers of your skin. To differentiate between melasma and another skin condition, a dermatologist may perform a skin biopsy by removing a small bit of skin.

Dermatologist-Approved Melasma Treatments

Topical Treatments

• Hydroquinone: Hydroquinone cream is a depigmentation agent that works by blocking an enzyme called tyrosinase. Application of a thin layer to the entire face one to two times per day may be effective in treating melasma. Results may take three to six months to appear, the cream should be applied to the entire face so no further uneven pigmentation happens. Use of Hydroquinone can be discontinued if no changes in pigmentation are seen after two to three months.
• Retinoids: Retinoids have anti-inflammatory properties which can help in reducing redness and irritation due to melasma. Retinoids can be harsh on the skin since for sensitive skin they can increase the skin’s sensitivity to the sun, hence for the treatment it’s better to start with a low concentration and gradually increase it to avoid skin irritation.
• Vitamin C Serums: Vitamin C isn’t the best treatment for melasma on the face or skin however one of the experiments which included 29 subjects applying vitamin C for 12 weeks to half their face, and distilled water to the other half, showed greater pigment decrease on the vitamin C side. Hence, vitamin C may help to reduce the appearance of pigmentation in the affected areas.

Chemical Peels

• Glycolic Acid Peels: Glycolic acid of concentration of around 6%–12% GA is a good priming agent for peels in melasma and can be combined with tretinoin or HQ.
• TCA Peels: TCA is a known efficient melasma treatment option since TCA can be used to penetrate deeply into the skin as melasma exists deep in skin layers.
• Combination Peels: Chemical peels that combine effective acids, such as retinoic acid, salicylic acid, kojic acid, vitamin C, glutathione, and tranexamic acid can be useful in the treatment of melasma.

Laser Therapy

• Fractional Laser Treatment: Fractional CO2 laser treatment takes months to show results but increases collagen production and creates new skin cells and layers which can significantly reduce the appearance of dark spots caused by melasma.
• IPL (Intense Pulsed Light) Therapy: Intense-pulsed light treatment for melasma is a therapy that uses a broad spectrum of light that produces heat to remove pigmentation. However, IPL should be used with consideration since it can result in more dark patches appearing.

Oral Medications

• Tranexamic Acid: Oral tranexamic acid is a promising melasma medication, consuming three times per day for 12 consecutive weeks, can result in effective treatment of melasma.
• Glutathione: Glutathione is an antioxidant found in our bodies and has been reported as an effective treatment for melasma since it reduces tyrosinase activity.

Combination Therapies

Multi-Modal Approaches: A step-by-step, multimodal approach can include a mix of treatments and procedures targeting melanin synthesis along with avoidance of UV light and hormonal contraception can be effective for melasma.

Professional Procedures for Melasma

• Microneedling: Gentle skin microneedling decreases epidermal melanin density, and helps in the production of epidermal thickening which restores the basement membrane helping in removing hyperpigmentation due to melasma.
• Microdermabrasion: Microdermabrasion is the removal of the outer layer of the skin that is associated with melasma which causes no damage to underlying skin, this can help in reducing the appearance of pigmentation due to melasma.
• Mesotherapy: Mesotherapy is injecting concentrated extracts essential for the skin, these absorb into the skin immediately and reduce melasma, freckles, and dark spots. This is a safe, fast and painless treatment of melasma.

Preparing for Melasma Treatment

Consultation with a Dermatologist

It is necessary to consult a dermatologist since they will be able to suggest and perform treatments that normal healthcare won’t do. Therefore before consulting a dermatologist, here is some information to consider before seeking a dermatologist:

When did the discolouration start appearing on your skin?

• In which places is the discolouration commonly seen?
• Any previous history of melasma in your family?
• Are you pregnant?
• What cosmetics do you use?
• Is there any skin disorder you are suffering from?

Understanding Treatment Options

If you are suffering from melasma the first thing to consider is to avoid melasma getting worse, hence try to avoid sun, tanning beds, LED screens, any cosmetics or soaps which you started using recently and birth control. Make sure you wear sunscreens all the time since exposure to sunlight worsens the condition.

After consulting your dermatologist, consider the use of topical medications. Consider the medications keeping in mind the side effects and dosage involved. If you want to go for treatments, consult and choose treatments which are suitable for your skin type.

Post-Treatment Care and Maintenance

Skincare Recommendations

Vitamin C

Since Vitamin C is proven to reduce Hyperpigmentation and discoloration on skin, it’s good to prep up the skin by using Vitamin C serum. However, since Vitamin C is not considered to alone reduce melasma, it’s better to use it in combination with other topical creams.

Skin-Lightening Creams

Skin lightening creams which have quality ingredients, Hydroquinone or skins containing Kojic acid, glycolic acid, azelaic acid, arbutin etc., can help lighten skin by inhibiting melanin production. However before using such creams it is important to consult your dermatologist once.

Sunscreen

It is important to protect melasma affected areas from sunlight exposure hence wear a sunscreen for melasma with broad-spectrum product with an SPF of 30 or higher, it’s better if you use sunscreens with PA +++ and IR filter for all round protection from the UV rays.

Moisturiser

Using moisturizing is essential since melasma is worse on dry skin, an effective moisturizer in par with a sunscreen can help to strengthen the skin barrier further which can promote skin healing due to melasma and melasma powered creams.

Dietary Considerations

Eat foods which are rich in Antioxidants like Vitamin C-rich foods, these foods protect the skin from damage and also reduce the melanin production, these nutrients can be found in fruits such as berries, or citrus rich fruits, leafy greens, and nuts. Foods that are rich in Omega-3 fatty acids help in reducing inflammation caused by melasma, eat fatty fish and nuts.

As always it is very important to stay hydrated since it is the key to healthy skin and can strengthen in healing melasma.

Managing Expectations and Possible Side Effects

Realistic Outcome Expectations

The results depend on the person and the medication used, hence overtreatment or aggressive treatment of Melasma can worsen the condition since it can be slow to respond to treatment. Therefore, when considering a medication it’s good to start slow and increase the dosage so it’s not hectic to manage and look out for side effects caused by such medications. This thing should also be kept in mind while considering therapy such as IPL or Laser Therapy.

Potential Side Effects of Treatment

Dermatitis is a side effect that is caused by creams containing hydroquinone and tretinoin. It is necessary to keep track of all the side effects and report all side effects to your dermatologist. Chemical peels and laser treatment can make layers of skin appear dead and may cause hyperpigmentation, and hypertrophic scars.

Conclusion:

Achieving Flawless Skin with Dermatologist-Approved Melasma Treatments

Even though melasma is a harmless condition, it can greatly affect a person’s confidence and self-esteem. To treat this condition it is important to know its causes and treatments.

There are numerous dermatologist-approved treatments available for melasma but each treatment has its benefits and potential side effects which range from person to person, so it is important to choose a treatment aligned to one’s skin type and other factors affecting the conditions this makes consulting with a dermatologist essential to determine the most suitable treatment plan.

While the journey to treating melasma can be long and requires patience, with the right approach and professional guidance, the condition can greatly improve their overall confidence and well-being.

FAQs

1. Can Melesma get itchy or hurt the skin?

Melesma is a harmless condition and it does not itch or hurt, however it can get worse if you don’t avoid radiation such as sun and makeups or soaps that can irritate the affected area.

2. How to prevent Melasma?

Unfortunately, many factors behind melasma are genetics or pregnancy which can’t be regulated, but it’s possible to avoid the triggers for melasma, so there is in fact no medication that can completely prevent melasma. It is possible to reduce the chances of causing melasma by eating a skin-friendly diet including adequate amounts of vitamin D.

3. Is it possible to use cosmetics and makeup if you have melasma?

Yes, but always pair cosmetics with sunscreen and avoid any cosmetics that can worsen or irritate the skin.

4. How long does it take for melasma to go away?

Even though melasma is long-lasting, it does fade away depending on the person or it can stay permanently or maybe it can respond to treatments. Preventative measures and treatments may cause melasma to disappear.

5. When should I see a dermatologist about melasma?

See your dermatologist as soon as you see signs of melasma, if it gets worse it will be harder to treat melasma.