Melasma (also known as Chloasma) is a blotchy, brownish pigmentation on the face of women that is hormonal and is exacerbated by sun exposure. There is a genetic predisposition to Melasma, and it is primarily triggered by pregnancy, hormonal contraceptives and sun exposure. It mostly affects women between the ages of 30 and 40 and is more common in those with dark skin.
A skin analysis can help determine whether facial pigmentation is due to Melasma, other skin diseases that cause pigmentation, sun damage or a combination of causes.
In Melasma it is important to try and assess if the pigment is superficial (Epidermal Melasma), deep (Dermal Melasma) or a combination of both (Mixed Melasma). Generally speaking, the more superficial the pigment, the more responsive it is to treatment.
The pigmentation in Melasma is due to the overproduction of melanin by the pigment cells in the skin (melanocytes). Melasma is a chronic skin problem and the aim of treatment is to try and control the condition rather than be able to cure it. Melasma can be very slow to respond to treatment, so patience is necessary. Successful treatment of Melasma requires a multi-pronged approach and however treated excess sun exposure in the future will cause recurrence.
Laser treatments, whilst they can be very effective, are not the first line of treatment.
The first line of treatment is with the use of skincare advice, sunscreen and topical creams. Start gently, especially if you have sensitive skin. Harsh therapies may result in irritation and even contact dermatitis, which can result in post-inflammatory pigmentation or rebound Melasma, where pigmentation actually worsens.
About 30% of patients with Melasma can achieve complete clearance with a prescription cream that contains a combination of hydroquinone, retinoic acid, and topical corticosteroid/anti-inflammatory.
Lasers are only used after simpler topical treatments have been tried first and these topical treatments are continued during laser treatments. There are a variety of possible Pigmentation laser options to treat Melasma and this is because there is no one best laser and a number of factors have to be weighed up to work out which Laser to use and when to consider changing to a different Laser option. In Melasma the pigment lasers aim to target excess melanin and shatter it into smaller particles that the body can remove. A series of treatments (4-6) are usually needed for the best results.
Broadband light (ie IPL) devices are best avoided in Melasma as they commonly cause worsening of the pigmentation. This is a key reason why it is important to distinguish Melasma from pigmentation due to sun damage as the treatments are quite different.
Melasma typically affects the forehead, cheeks and upper lips resulting in macules (freckle-like spots) and larger patches. Occasionally it spreads to involve the sides of the neck, and a similar condition may affect the shoulders and upper arms.
On the face, it tends to occur in three patterns:
Melasma is sometimes separated into epidermal (skin surface), dermal (deeper), and mixed types. Epidermal melasma, which is more superficial, tends to have well-defined borders, is darker brown in colour and becomes highlighted under Wood’s lamp illumination. Epidermal melasma tends to respond better to treatment than dermal melasma, which is lighter brown in colour. Mixed melasma, which comprises a combination of light and brown patches improves with treatment, but not as much as epidermal melasma.
Unfortunately, even in those that get a good result from treatment, pigmentation may reappear on exposure to summer sun and/or because of hormonal factors.
A combination of the following measures is helpful:
Skin preparation before the laser treatment of Melasma is critical to getting the best result and minimising any risk of rebound pigmentation. Patients with Melasma should already be on a skincare program before laser treatment and this may be supplemented with a prescription depigmenting formula for at least 2 weeks before laser treatment. Sun exposure should be avoided and sunscreen used daily for at least 2 weeks before any laser treatment of pigmentation. In Melasma the use of sunscreen and sun avoidance should already be part of your treatment program.
A cold pack is used and a soothing cream applied after laser treatment of Melasma. Some darkening of the treated area can occur but a breathable make up such as Lycogel can be used if needed. Sunscreen and sun avoidance are again very important.
Before and after images are presented purely as a reference point of the results that can be achieved. Everyone is unique and outcomes will vary and realistic expectations need to be discussed on a case by case basis.
Got questions? Or ready to book in? Contact our experienced and friendly team to start your journey to healthy skin with us.