Medicosnext
Words by Dr Priya Bhusal
“Melasma, while primarily a cosmetic concern, can have a significant impact on a person’s self-esteem and emotional well-being.”
“Sunscreen is the cornerstone of melasma prevention. Choose the right sunscreen with a sun protection factor (SPF) of 30 or higher, as recommended by dermatologists. Strict sun protection is the mainstay of any melasma treatment regimen.”
Melasma is a common skin condition that affects individuals worldwide, causing dark, brown to grayish patches on the face, especially on the cheeks, forehead, and upper lip. As a dermatologist, I encounter many patients seeking help for this cosmetic concern. In this article, we delve into the causes available treatment options, and preventive strategies for melasma to help individuals in their journey towards clearer and healthier skin.
Why does melasma occur?
Melasma occurs due to an overproduction of melanin, the pigment responsible for skin color. Abnormalities in melanocyte function, increased melanin production, and its uneven distribution in the epidermal and dermal layers contribute to the characteristic discoloration. While the exact cause remains unclear, several factors contribute to its development, including genetics, hormonal changes, certain medications, thyroid disease. Ultraviolet (UV) radiation exposure from the sun is another critical trigger, especially in regions with intense sunlight. Women, especially during pregnancy or while using hormonal contraceptives, are more susceptible to melasma.
Diagnosis of Melasma
A thorough evaluation by a dermatologist is essential for a precise diagnosis. Typically, melasma presents as symmetrical, irregularly shaped, and dark patches on the face. A Wood’s lamp examination or a specialized light device may be used to visualize the extent of the pigmentation. Differentiating melasma from other skin conditions with similar appearances is crucial to tailor the most appropriate treatment plan.
Treatment Options:
Current treatment options for melasma include topical and oral medications, chemical peels, laser and light therapy,microneedling, mesotherapy, and combination treatment.
- Topical Medications: Topical agents, such as hydroquinone, kojic acid, tranexamic acid, azelaic acid, niacinamide, rucinol etc are prescribed to lighten pigmented areas, reduce inflammation and promote skin rejuvenation. These treatments should be used cautiously under medical supervision due to potential side effects.
- Oral tranexamic acid has shown promising results in the treatment of melasma. It works by reducing melanin production and by reducing excess blood vessels in the skin.
- Chemical Peels: Chemical peels involve the application of a chemical solution to exfoliate the skin, leading to the removal of damaged cells and excess pigment in melasma patients. This includes glycolic acid, mandelic acid, lactic acid etc
- Laser and Light Therapy: Various laser treatments including Q-switched Nd:YAG laser, Pico Laser, IPL can selectively target melanin and reduce pigmentation. Multiple sessions may be required for optimal results.
- Microneedling and Mesotherapy: This minimally invasive procedure creates microscopic channels in your skin and delivers drugs into your skin to improve your skin tone and reduce pigmentation
- Combination Therapies: In most patients a combination therapy is needed that includes topical medications, chemical peels, and laser treatments tailored to the individual’s needs. When you follow your treatment plan, it usually takes between 3 to 9 months to see better results. The treatment process may require patience and consistency.
Role of Sunscreen in Melasma Prevention
After achieving improvement with the above treatments, maintenance therapy with topical agents and sun protection is essential to prevent melasma recurrence. Sunscreen is the cornerstone of melasma prevention.Choose the right sunscreen with a sun protection factor (SPF) of 30 or higher, as recommended by dermatologists. Additionally, look for “broad-spectrum” on the label, ensuring protection against both UVA and UVB rays.For optimal protection, apply a generous amount of sunscreen to all exposed areas at least 15 minutes before sun exposure. Reapply every two hours, or more frequently if swimming or perspiring heavily. Strict sun protection is the mainstay of any melasma treatment regimen.
Conclusion
Melasma, while primarily a cosmetic concern, can have a significant impact on a person’s self-esteem and emotional well-being. As a dermatologist, my goal is to help patients achieve clearer and healthier skin while understanding the underlying triggers. Since none of the available treatments is a cure, prevention is the best option. It is essential to consult a dermatologist for a personalized treatment plan based on the severity of melasma, skin type, medical history and to maintain the treatment results.
