Pigmentation & Brightening
What is Melasma?
Melasma is a common form of dark skin pigmentation that usually appears on the forehead, cheeks, upper lip and chin. It can appear as a light tan, dark patchy brown or blue-grey skin discoloration.
Melasma is caused by overactive melanocytes in the skin. Melanocytes are the cells responsible for producing melanin, a pigment that darkens the skin and protects it from harmful UV rays.
Melasma affects about 45-50 million people world-wide but is more common in women. Over 90% of those affected by melasma are women aged 20 to 50 years. It is more common in women with olive or darker skin types, including those of Asian, Mediterranean or Middle Eastern heritage.
Melasma is thought to be caused by an underlying genetic condition that can be exasperated by hormonal factors, skin diseases and sun exposure. When melasma occurs during pregnancy, it is referred to as chloasma, or “the mask of pregnancy.”
Treatments can include topical medications, such as 4% hydroquinone, chemical peels, fraxel lasers and natural whitening creams. Care must be taken with chemical peels and laser treatment because, if treated inappropriately, the melasma and pigmentation problems can actually worsen.
This condition can re-occur so having both a treatment and prevention program in place is the foundation to achieving more long lasting results. Prevention is largely aimed at protecting the face from sun exposure and/or sun avoidance
What Causes Melasma?
- Genetic– some people may have a family history of melasma and others might be pre-disposed to this condition. For example, Melasma is more common in females and particularly those of darker skin races, such as Asian, Mediterranean or Middle Eastern extraction.
- Hormonal – Some people will have melanocytes that are more sensitive to changes in hormonal levels. Changes caused by pregnancy, birth control pills (oestrogen) and hormone replacement therapy can often stimulate the pigment producing cells, resulting in excessive pigmentation.
While pregnant women experience increased levels of oestrogen, progesterone, and melanocyte-stimulating hormone (MSH) in the 2nd and 3rd trimesters of pregnancy it is thought that pregnancy-related melasma is caused by the presence of increased levels of progesterone rather than oestrogen and MSH.
- UV exposure (sunlight) – Most people with melasma are seen to have a history of daily or frequent sun exposure. Even brief exposure to UV light can stimulate the production of melanin in the skin so the use of a good sunscreen is an important part of treating melasma.
- Skin Irritation – active inflammation of the skin from heat, acne outbreaks or skin disease can sometimes cause melasma.
Types of Melasma
There are different types of melasma that vary in their pigmentation pattern and location.
- Epidermal melasma is an excess of melanin in the superficial skin layers. It mostly appears as a tan color.
- Deep or dermal melasma is found lower in the dermis of the skin. It is usually a darker color and is best treated with a combination of creams and/or Fraxel Laser.
- Mixed type melasma includes both the epidermal and dermal types and is often the most difficult to treat. This form of skin darkening is usually more common in darker skinned races.