Understanding Melasma

Melasma

In Asia, melasma is a very prevalent and common problem. It most typically occurs with lightly pigmented skin types such as Asian and Hispanic skin, and also presents more commonly in women. Melasma can be caused by frequent exposure to the sun, but is also known to be caused by female hormonal changes due  to pregnancy or the use of oral contraceptive pills. Some patients are also found to have a genetic predisposition to the condition.

What is melasma?
Melasma typically occurs in three patterns: centro-facial - occurring on the forehead, cheeks, upper lip, nose and chin areas, malar - occurring on the upper cheek areas and mandibular - which is specific to the jaw line and sides of the cheek.

Melasma differs from freckles in that freckles are generally spread over wide areas of the face and occur as small, darkened spots of various sizes. Melasma that occurs in the epiderrmis (top layers of skin) responds better to treatment than dermal melasma. 

As melasma can build up very gradually over a number of years, proper diagnosis and treatment may not be sought until the melasma is at a very advanced or pronounced stage. Early stages of the condition may be only visible with the use of a Wood's lamp or computerised facial analysis system.

Treatment of melasma
Melasma treatment can be very difficult, as the pigmentation can be worsened with the wrong care. Physicians may choose to explore different options as different patients respond to different types of treatment. Epidermal melasma is the easiest to treat, with dermal melasma often recurring very rapidly after cessation of treatment. Hence, identification of melasma type can be a very important factor in  Here are some clinically-tested treatments for melasma that are the best available on the Asian market at the moment.

Tri-Luma
Tri-Luma is an FDA-approved treatment for melasma. It is a topical cream treatment for melasma that is well-tolerated and works well for most patients. It is a combination of hydroquinone - a lightening agent, Tretinoin - vitamin A derivative, and fluocinolone - an anti-inflammatory agent, and can be very effective if properly used.
The cream is applied to the affected areas once daily, and is effective within 6 - 8 weeks of use.



Cosmelan
Cosmelan is a facial mask treatment that works on facial pigmentation by inhibiting tyrosinase, an enzyme in the melanin formation process. The mask is applied by a doctor, and it is left on for a set number of hours depending on each patient's requirements. Peeling of the skin occurs on the second day of treatment, and usually resolves within the next few days to leave the skin clearer, smoother and more refined.
The treatment is combined with a topical skin treatment that the patient applies at home.

Fraxel
The Fraxel Re:store DUAL laser is the only laser that is FDA approved for the treatment of melasma. The treatment for melasma differs from that of other conditions, so it is important that the proper settings for melasma are used when Fraxel is given. In certain cases, the wrong Fraxel settings can result in a worsening of the melasma. Patients may be given a topical treatment such as Tri-Luma for pre- or post-treatment care. Treatments are typically given monthly for a three to four month period, and a few days' downtime as the skin darkens and peels is normal after every treatment.

IPL
IPL or Intense Pulsed Light is a very commonly found therapy that even beauty salons are offering today. While there are many horror stories of botched treatments and intensification of melasma pigmentation after such treatments, studies have shown that melasma can be very effectively treated with the right settings and protocol on an IPL machine. Li, et al. showed in a 2008 study conducted at the China Medical University in Shenyang, China, that 69 out of 89 Chinese women suffering from melasma, obtained a 51% to 100% improvement in their condition after a total of four IPL treatments in 3 week intervals.


Melasma can be successfully treated, but improvement usually takes time and repeated treatments,and may require a combination of different modalities for full effectiveness. Proper sun care, with sun avoidance, usage of hats or covers or high SPF sunscreen is a very important factor for successful resolution of the problem. In many cases, unless exposure to the sun or to hormonal factors can be minimised, melasma will recur after the prescribed treatment.

CosMed, MD