Causes of Melasma

The pigmentation is a result of the overproduction of melanin. People who tan easily or have naturally brown skin are prone to melasma because they have more active melanocytes compared to people with lighter skin.

Melasma depends on your genetic predisposition. A few of the other triggering factors are:

Sun exposure:

Uncontrolled exposure to the sun is the leading trigger as UV light from the sun stimulates the melanocytes, increasing melanin production.

Hormonal changes:

Internal hormonal changes, as seen in pregnancy, stress, thyroid disorders as well as exogenous hormone treatments in the form of oral contraceptives, intrauterine devices, hormone replacement therapy, are all implicated in the triggering of melasma.

Medications:

Certain medications like anti-seizure drugs, anti malignant drugs could also act as triggers.

Skincare products:

Scented soaps, toiletries, cosmetics and skin care products that irritate the skin. This may increase melanin production and accelerate melasma symptoms.

Types of Melasma

Epidermal melanosis:

In this condition, excess melanin layers on keratinocytes are present in the epidermis. In fact, this type of melasma has patches with well-defined borders and responds well to treatment.

Dermal melanosis:

In this condition, the excess melanin may be deposited in the inner layer of skin called the dermis. Moreover, this type of melasma has unclear borders and does not respond well to treatment.

Mixed:

In this condition, pigmentation occurs in the epidermis as well as the dermis.

Patterns of Melasma

Melasma occurs on both sides of the face, indistinct patterns such as –
Centrofacial pattern: This occurs on the forehead, cheeks, nose, and upper lip. This is the most common pattern.
Malar pattern: This occurs on the cheeks and nose.
Mandibular pattern: This occurs on the jawline.

Melasma Treatment Methods

While there is no cure for melasma, many successful treatment options have emerged in current times. Whatever be the most suitable treatment for your skin, it is essential to keep your face and affected areas protected from the sun during and after the treatment. This means when you’re hitting outdoors, or even when inside, you should always wear sunscreen. And this habit must be maintained even after the treatment so as to ensure the problems do not re-occur. Sunscreen will protect your skin against UV rays, a common trigger for melasma that makes hyperpigmentation darker.

Other recommendations include avoiding the use of face washes and creams that may be an irritant for your skin as this may worsen melasma.

Here are some common melasma treatment methods that dermatologists recommend:

Hydroquinone:

Hydroquinones help in reducing pigmentation due to melasma. They act by inhibiting an enzyme called tyrosinase that is essential for the production of melanin. It is considered a standard treatment for melasma.

Hydroquinone is a lightening or depigmenting topical agent which is available in cream, lotion, gel, or liquid forms. In fact, it is available over the counter in low doses (2%), and by prescription in higher doses (4%). However, it causes the darkening of skin with overuse at high concentrations for a prolonged period. If this happens, it should be discontinued immediately.

Who should try this?

If you have hyperpigmentation like freckles or melasma, or acne scars, then you can go for hydroquinone melasma treatment in Pune. It is considered a gold-standard in the treatment of this skin condition. If used in combination with other agents, its efficiency can further be enhanced. After proper assessment of the skin and diagnosis of the condition, the patient can opt for hydroquinone to treat melasma.

Retinoids and corticosteroids:

Retinoids resolve melasma by increasing skin cell turnover and allow fresh cells to form quickly. Tretinoin is the commonly used derivative and is even available in combination with hydroquinone or azelaic acid. It may lead to mild side effects like peeling, dry skin, and irritation.

Who should try this?

This melasma treatment in Pune is great for patients who have melasma on their face, and want to lighten the pigmentation.

Other topical medication:

A range of creams is available for skin lightening. These creams don’t bleach the skin but instead, act on the pigment-producing cells that reduce the darkening of the skin. The most common compounds in these creams are hydroquinone kojic acid, glycolic acid, Azelaic acid, Arbutin, Vitamin C, and Niacinamide. Tranexamic acid, a procoagulant agent, is another popular medication that is widely used in the treatment of melasma. Its topical (and oral) formulations have shown good results. Remember, the effect of these topical solutions is not permanent and requires at least three months to show results. Always wear sunscreen over these creams before stepping out.

Who should try this?

Topical medication is required in all the patients of melasma. However, its strength, duration, and choice of topical and oral agents vary, depending on the type and depth of melasma in patients. Those with deeper pigmentation usually require a combination of other treatments in addition to oral and topical medications.

Chemical peels:

Chemicals – which are derived from natural sources like fruits, almonds, and sour milk – are used to exfoliate the superficial layers of the skin. They also help reduce the pigment in the upper layers of the epidermis. The degree of pigmentation decides the concentration of the acid and the number of sessions required. Chemical peeling may cause a few side-effects such as irritation, redness, and peeling in a few individuals. (Such side-effects can be minimized or avoided if the procedure is done by a trained and experienced professional.) In the case of deeper peels, you will also need to make an allowance for recovery time after the procedure. The dermatologist will choose the type and strength of the chemical peel best suited to the individuals’ skin type. In fact, only dermatologists must administer Chemical peels.

Who should try this?

Chemical peels are suitable for candidates who want to improve the epidermal hyperpigmentation. Various peels like glycolic acid, Trichloroacetic acid peel, Retinoic acid peel, or combination peels are used in treating melasma.

It’s worth noting that chemical peels should ideally be used in combination with other treatment options for the faster and better clearance of melasma.

Microdermabrasion:

This non-invasive, non-chemical method of exfoliation uses vacuum suction and abrasive material. Microdermabrasion is usually used in combination with other methods of treatment for better results.

Who should try this?

This treatment is suitable for candidates who are looking to reduce the appearance of fine lines, wrinkles, and hyperpigmentation that occurs due to melasma, which itself is a result of hormonal changes, sun exposure, and several other factors.

Laser therapy:

Different types of potent lasers have been used for the treatment of melasma. These include the Q-switched laser. Though they are one of the most effective forms of treatment for melasma with permanent results, the results have not been consistent. Treatment for melasma with lasers requires skilled and qualified doctors who may decide to couple the treatment with other procedures and creams for maximum effect. The cost of laser treatment for melasma depends on several factors. It is advisable to consult your specialist and understand the best treatment plan for you, which will then decide the cost of the treatment.

Who should try this?

Q switch laser for melasma is best suited for people with a dusky complexion, but it’s not recommended as monotherapy. The treatment has to be combined with other procedures like peels and oral medicines for the best results.

Sun protection: Sun protection is one of the most important aspects of the treatment of melasma. Always wear sunscreen with an SPF (sun protection factor) of at least 35. The sunscreen should be broad-spectrum, meaning it should offer protection against UV-A and UV-B radiation from the sun. Apply sunscreen at least fifteen minutes before you leave your house and re-apply every two to three hours. Sunscreens can be applied over any topical medication or creams.

One way to speed up your melasma recovery process is to have sufficient sun protection during the process. You have to use a broad-spectrum sunscreen, whenever you step out – even on cloudy days. The sunscreen must contain UVA and UVB blocking agents like zinc or titanium dioxide. Patients who want to reduce the appearance of their melasma should take on various methods of sun protection; this includes avoiding sun exposure, as much as possible; especially, during the peak hours of the day. Wear a hat, cover your arms and chest with sun-protective clothes, and seek shade whenever possible.