What is Melasma?

Melasma is the deposition of excessive pigmentation in the epidermis and or dermis of skin in well-defined patterns over the face, hands, or forearms rarely.

Melanocytes are the cells that generate pigment in the skin. This amount and quantity of pigment determines our skin colour. People with pheomelanin, or the lighter pigment, have blonde hair, fair skin, and light eyes. Whereas our Indian population has a higher proportion of eumelanin, which is darker.

When these melanocytes go into a hyperdrive of making more melanin than normal, it results in hyperpigmentation, which most people call pigmentation.

The distribution and the cause of the pigment determine the type of hyperpigmentation. When this hyperpigmentation is seen in patches over one or more of these sites, i.e., cheeks, forehead, bridge of nose, chin, forearms, nape of neck, it is called melasma.

Mostly, the diagnosis of melasma is clinical and does not require a biopsy to confirm it.

What are the causes of melasma?

The list of the causes of melasma is extensive and elaborate.

For any of the following reasons, melasma can be triggered:

  • Excessive sun exposure
  • Photosensitizing skin care products
  • Oral contraception
  • Emergency contraception
  • Pregnancy
  • Stress
  • Antidepressants
  • Iron deficiency anaemia
  • Malnutrition
  • Crash diets
  • Androgens
  • Anabolic steroids
  • Over exfoliation
  • Home-based peels
  • Excessive peels
  • Tanning beds

What are the types of melasma?

The type of melasma is determined by the depth of pigment in the skin.

When the pigment is limited to the upper layer of skin, it is called epiderma melasma. It is darker in colour and tends more towards black in shade. However, when the pigment is deeper in the skin, it is called dermal melasma. This melasma looks lighter in color but is more brown in color.

The epidermal melasma is mostly seen in early stages i.e., upto 1 year of pigmentation visibility and the dermal melasma is seen in later stages. The epidermal melasma responds to the treatment better than dermal melasma.

Why does one get melasma?

The predisposition to getting melasma is genetic. Also, the lifestyle contributes. Bad lifestyle choices like smoking, alcohol, and sugar can increase the probability of melasma.

People who stay outdoors, like athletes, construction heads, travellers, and real estate agents, get melasma more frequently and are poor treatment responders unless they change their lifestyle and stay indoors.

Some people may get melasma due to ongoing medication.

Women often develop melasma due to hormonal imbalances, oral contraceptive use, pregnancy, abortions, miscarriages, etc..

Young girls mostly develop melasma due to malnutrition, iron deficiency anemia.

Is melasma only seen in women?

Contrary to popular belief, men are prone to melasma too.

The main causes of melasma in men is stress, smoking, outdoor exposure, poor nutrition, or genetics.

However, it becomes harder to treat melasma in men due to more outdoor exposure and a reluctance to apply sunscreen.

What blood tests are needed before starting the treatment?

When you visit the doctor, you might be asked to get some blood tests done.

These would include

  • Complete Blood Counts
  • Iron studies
  • Vitamin B12 levels
  • Vitamin D levels
  • Hormone profile

How can melasma be treated?

Treating melasma requires a basic understanding of the condition by the patient. Failing to do so may cause anxiety, unrealistic expectations, failure to adhere to treatment, and so on. Also, this requires a level of faith between the patient and the doctor because it is like running a marathon and not a sprint. Cooperation and good decision-making are required on both sides.

Melasma treatment is extensive and includes methods that work on various levels, like:

  • Preventing pigment formation
  • Breaking existing pigment
  • Correcting the underlying cause
  • Maintaining the reduction in pigment for a long time

Treatment that works for preventing new pigment formation includes:

  • Physical sun protection with caps, hats, and clothes
  • Sunscreen usage
  • Tyrosinase inhibitors

Treatments that work by breaking down the existing pigment include:

  • Laser toning
  • Chemical peels
  • Microneedling
  • Mesotherapy

Treatments that work by treating the underlying cause include:

  • Iron therapy
  • Oral antiandrogens
  • IV antioxidants
  • Mindfulness and relaxation therapy

Is melasma curable?

Melasma is treatable and curable if it has an underlying correctable cause.

Though it needs measures to be taken for a long time.

However, it is recommended that the topical creams used to treat melasma should be safe for long-term usage.

How to prevent a recurrence of melasma?

  • Regular and strict sun protection
  • Regular sunscreen use
  • Avoiding undue sun exposure
  • Stopping any medicine or substituting which can cause melasma
  • Take maintenance treatments every 2-3 months

How do chemical peels improve melasma?

Chemical peels improve the cell turnover of the epidermis, which reduces the efficacy of melanin spread into the epidermis, hence the skin starts to appear lighter in colour.

There are various types of peels that are helpful in pigmentation, like AHA, BHA, phenol, retinol, TCA, Mandelic acid, Vitamin C, Acetic acid, etc.

The peel partially or completely removes the superficial layer of skin and stimulates the regeneration of new cells, which will have less pigmentation than before. Chemical peels should be performed every 4-6 weeks and then maintained every 2-3 months. Most chemical peels are very safe and satisfactory.

Strict sun protection and sunscreen application are needed after chemical peels. Prior to a chemical peel, your skin might need priming with tretinoin or glycolic acid so that you can get the most out of your session.

A chemical peel is a 15-to-30-minute procedure that can be done at any time of the day. After a chemical peel, you can immediately resume your daily activities except the ones that require you to be outdoors or in the pool.

How do lasers help in pigmentation?

Laser toning with a Q-switched Nd YAG laser targets the melanin in the skin. The melanin, after absorbing the laser light, undergoes intense vibrations and breaks down into smaller particles. These melanin particles are then removed by the macrophages in the dermis of the skin.

Laser toning for pigmentation is a safe procedure when done by a trained professional. It is done every 15-21 days. After laser toning, you will need to apply moisturizers and sunscreen regularly.

How does Microneedling improve Melasma?

Microneedling delivers skin lightening agents directly to the dermis, which works on all levels of pigmentation reduction. It assists in performing the following functions:

  • It stops pigment formation.
  • It doesn’t let pigment transfer to the skin cells.
  • It improves the pigment breakdown.
  • Assists in the destruction of pigment.
  • It also reduces local skin stressors and improves skin quality.

How long will it take for you to see results of the treatment?

The skin cycle takes 4 weeks for a new layer to form, where one melanocyte has a life cycle of 10–12 months. You would be able to see the results in 6-8 weeks with safe and effective treatment. Moreover, the treatment will need maintenance for 12 months as it is a condition that requires care for a long time.

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