Melasma, a condition primarily seen in women, involves increased pigmentation (hyperpigmentation) of the skin on the face. Frequently associated with hormonal upheaval, it often occurs during pregnancy or with the use of oral contraceptives.
Thought to have an incidence of 50-70% in pregnant women, the onset of melasma is usually during the second half of pregnancy. It also occurs in at least 20% of women taking birth control pills which means, of course, that the condition has increased in frequency now that the use of oral contraceptives is more widespread amongst women. The age of onset is also becoming lower as women in their early teens often use oral contraceptives. Melasma can also occur in women who have never been on birth control pills and who have never been pregnant. The skin condition occasionally occurs in children too, as well as in men, with the estrogen and progesterone hormones in the human body involved in stimulating melanocyte activity (i.e. increasing production of the pigment melanin).
Causes
1) As previously mentioned it is known that increased estrogen levels associated with pregnancy and oral contraceptive use are the main triggers for Melasma. However, ultraviolet radiation exposure is the next major cause of the condition, either through exposure to SUNLIGHT or from tanning beds.
2) Around 25-30% of those with Melasma are thought to be genetically predisposed to the condition.
3) Perfumed ingredients in cosmetics, creams, lotions and cleansers also appear to play a significant role in Melasma development. Therefore, it is wise to avoid the use of such agents on the skin of the face and hands so as to minimize sensitivity and reduce the risk of exaggerated photo-reaction to UV light exposure resulting in increased melanocyte activity.
Clinical Features
Hyperpigmentation can occur on any part of the body, although Melasma tends to follow a specific pattern as it develops on the face, giving rise to the longstanding name the ‘mask of pregnancy.’ Melasma generally presents as an asymmetrical, irregular brown or tan discoloration on the face, albeit with rather sharp borders. The coloration varies from very light to dark brown and this tends to be dictated more by the natural undertone of the skin. It can start out very subtle and barely noticeable but with each year the affected area is further affected by sun exposure as the cells retain the memory of the previous effects leading to the discoloration darkening and increasing in scope.
Various Treatment Options
Dr. Bakken has been treating this condition in her dermatology practice since 1978. For decades the mainstay of treatment has been the application of topical ‘bleaching agents’ of which the main one has been Hydroquinone. Hydroquinone is an enzyme inhibitor that works on three different melanin production pathways. Over time, Dr. Bakken has incorporated this long used inhibitor with other enzyme inhibitors in various formulas for better effect. The Circadia peel offered by Laser and Skin Care Medspa for the past several years includes two of these known enzyme inhibitors, Mandelic Acid and Retinoic Acid (vitamin A). This formulation continues to offer great success in treating some of the superficial Melasma.
In addition to the use of Circadia there are other topical options that Dr. Bakken may suggest during your consultation.
Fractional Lasers
Over the last decade there have been great advances in the development of technology in the successful treatment of Melasma. A special category of lasers, called fractional laser systems, have been designed, as the name implies, to break up sub particles in the skin and create pigmentation changes. Refinement of these lasers and techniques has revealed one of the three main types of laser, the Irbium- YAG laser as particularly adept in Melasma treatment. Laser and Skin Care Medspa has been providing this advanced laser alongside the Palomar system since 2007 as part of our anti-aging technology.
The great thing about this advanced treatment is that there is little to no downtime required afterwards and the skin can be protected with water based products such as Skin Medica Total Defense & Repair SPF 50, Alyria SPF 45 or the Jane Iredale makeup line. In most cases it is necessary to repeat the treatments at monthly intervals until the Melasma is cleared. Dr. Bakken often recommends the use of a topical preparation for one to two months prior to use of the fractional laser, having found that this leads to a higher success rate overall with fewer treatments required and increased patient satisfaction.
Spectra Laser
Spectra (nanopulse Nd: YAG laser) was introduced in 2012 for the treatment of Melasma, and has shown to be very effective in reducing the appearance of the condition. It is important to be diligent with sunblock application as Melasma can reappear with sun exposure. The laser energy targets the pigment which breaks it down and ablates it. The body’s immune system then naturally removes the pigment particles.
Preventing Recurrence
Avoiding further pregnancy and the use of birth control pills is not, unfortunately, sufficient to avoid the return of Melasma. All it takes is one day of unprotected sun exposure and the hyperpigmentation can all come back as before. The key, then, to preventing Melasma in the first place, and minimizing the risk of recurrence, is the diligent use of SUNBLOCK. Elsewhere on the site I have discussed the difference between chemical and physical sunblock and why physical barriers are safer and more effective. (See blog -The Confusing Story of Sunscreens and Sunblocks) Physical blocks are more effective for sun protection as they reflect UV light, as opposed to absorbing UV light and then chemically treating it, which is what chemical sunscreens do. Controlling Melasma requires a dedicated lifestyle change to include an effective physical sunblock as part of your daily routine. Laser and Skin Care Medspa carries several physical sunblocks, such as, Total Defense & Repair SPF 50 or Alyria SPF 45 among our cosmetic medical dermatology lines which are easy to wear and which do not aggravate acne or sensitive skin.
It should go without saying that it’s a good idea to avoid spraying and applying perfumes or perfumed cosmetics/toiletries to the face to reduce the risk of Melasma recurrence and to prevent initial onset of Melasma.
MELASMA is essentially an aesthetic condition that is undesirable and can affect self confidence and self-esteem. That blotchy complexion tends to add years to the appearance when you may be trying hard with other skin treatments to rejuvenate the face. The good news is that the majority of those affected can be effectively treated and offered a long term Melasma management plan to prevent the condition recurring.