Melasma is a form of pigmentation stimulated by hormones and UV sun exposure. The hormones may be as a result of pregnancy, the contraceptive pill or hormone replacement therapy and in some susceptible woman their normal circulating hormones can be responsible. Melasma, typically occurs as dark areas and darkened pigmentation on sun exposed facial areas, mainly seen on the cheeks, forehead, upper lip and nose.
MELASMA IS CONSIDERED A VERY DIFFICULT CONDITION TO TREAT THAT CAN NEVER BE CURED, BUT IT CAN BE CONTROLLED TO MINIMISE ITS APPEARANCE.
In some patients their melasma can be very sensitive to oestrogen and if on the oral contraceptive a low oestrogen pill should be considered as it will be less likely to aggravate their melasma.
UV protection and avoidance are important in the treatment of melasma. Most women first notice the appearance of melasma during or after a summer where they have had significant UV exposure. Using a SPF 30+ sunscreen on a daily basis (regardless of the weather) and sun avoidance on the face (obtaining shade wherever possible) are very important in managing melasma.
Topical products are the first line of treatment for melasma. Topical Niacinamide (vitamin B3) has been shown to suppress the distribution of pigment in skin cells and to help regulate excessive pigmentation. For more severe cases topical prescription products such as hydroquinone are considered. Hydroquinone is a lightening agent and an exfoliator that helps to lighten excess pigmentation but maintain normal pigmentation.
Laser treatments are a very effective option for more severe melasma or when topical products have not been very effective. The FRAXEL laser is an approved option for the treatment of melasma using the 1927 wavelength of light. FRAXEL treatment is able to precisely treat thousands of microscopic areas of the skin, it uses pin point laser beams that penetrate beneath the skins surface to eliminate excess pigmentation.
The FRAXEL is a fractional laser which allows the pigmentation to break down with minimal damage to the normal surrounding skin. Usually 2-3 treatments are required spaced 4 weeks apart. People with Asian or darker skin types need to go on topical products pre and post FRAXEL treatment to get the best result and minimise what is called PIH (Post Inflammatory Hyperpigmentation). PIH is where other pigmentation can develop as a result of the inflammatory effect of the laser treatment. In certain situations the best laser treatment option for melasma can be with REVLITE laser technology.
The REVLITE protocol can be a worthwhile option for patients at higher risk of PIH and involves a series of 4-6 low power treatments. The REVLITE laser protocol has less downtime and is not as expensive as the FRAXEL protocol but requires more treatments and is less effective when the melasma involves more deeper dermal pigmentation.
It is important to note that melasma is a chronic skin condition and cannot be cured. It should be considered like hypertension, it can’t be cured but it can be controlled. FRAXEL laser, REVLITE laser and topical treatments and products will help in the treatment and reduction of melasma. A combination treatment approach is necessary for more severe melasma with sunblock, bleaching agent and laser treatment being required for the best result. Unfortunately melasma has a strong tendency to return, so maintenance treatments are essential. Remember if you have a tendency to melasma and you have excess sun exposure the melasma will recur.