Melasma: Causes and Treatments

A common skin condition that affects millions of individuals worldwide, Melasma is more prevalent in women than in men. Melasma appears as irregularly shaped skin discoloration on the faces of affected individuals. The cheeks, forehead, bridge of the nose and upper lip are most commonly involved. Individuals with light brown skin tones are amongst those most affected and while it is cosmetically disfiguring, it tends not to cause any other symptoms beyond the skin discoloration.
Chloasma or “mask of pregnancy” is the name for Melasma associated with pregnancy.
What Causes Melasma?
Melasma may be triggered by hormonal changes related to estrogen and/or progesterone as found during pregnancy or with the use of the birth control pill. A genetic susceptibility may be involved and while the exact cause is unknown, melanocytes - the skin’s pigment producing cells - are stimulated resulting in the production of excess melanin.
Exposure to UV rays may also stimulate melanocytes and contribute to Melasma. In fact, it’s thought that darker skinned individuals are affected more as they have more melanocytes than lighter skinned individuals.
Treatment of Melasma
Skin discoloration may resolve spontaneously if the hormonal changes associated with pregnancy or the use of birth control pills stop. However, Melasma may also remain for many years. While there’s no cure for Melasma, it can be managed by using a number of effective skin care ingredients that work in different ways. You’ll obtain the best results by combining agents that complement one another. Here’s an overview of ingredients to consider:
1. Sunscreens. Nothing is more important in the management of Melasma than the use of a well formulated UVA and UVB blocking sunscreen. UV rays can stimulate melanocytes within minutes so if you can’t avoid the sun (which should be your first choice), then wear a high SPF sunscreen daily, year round. UVA rays are prevalent all year round and can penetrate clouds and windows; don’t think you’re safe if you’re inside sitting by a window.
2. Bleaching creams. Technically not “bleaching creams”, these creams lighten skin by decreasing the activity of melanocytes at various stages. The result is decreased pigmentation. Bleaching creams incorporate a range of ingredients and are often combined together in formulations with other agents for maximum benefit.
Hydroquinone is still regarded as the gold standard for hyperpigmentation disorders. It is an effective inhibitor of tyrosinase, the enzyme responsible for the synthesis of melanin, the skin’s pigment. Though there are some safety concerns with its use, if used at recommended doses (4% or less) or under a physician’s guidance, it’s well tolerated and effective. Hydroquinone is often combined with other products such as prescription retinoids, over the counter retinol or alpha hydroxy acids. It may also be combined with other botanical skin lightening agents including arbutin, Rumex occidentalis, Gigawhite or kojic acid.
3. Alpha Hydroxy Acids (AHAs) such as glycolic acid, lactic acid, malic acid or mandelic acid exfoliate the skin’s top layer thereby removing pigmentation. Research has shown that they may also inhibit the production of melanin. AHAs are often added to bleaching agents to increase their penetration as well as remove pigmentation.
4. Vitamin C has demonstrated skin brightening properties at concentrations 5% or higher. Products incorporating Vitamin C make a useful adjunct to the treatment of Melasma.
5. Retinoids increase skin cell turnover and are often combined with hydroquinone to effectively attack skin discoloration. Retinoids can be continued indefinitely as it has many skin benefits beyond the management of Melasma. Studies have shown than retinoids can also stimulate collagen production, unclog pores, and increase skin thickness.
6. Chemical peels and laser treatments have been shown to deliver mixed results. If you choose this option, always work with a qualified professional, as there is the risk for skin injury.
Melasma won’t resolve quickly. Successful treatment may take months and you may have to try a number of products before finding a regimen that delivers. Once you’ve achieved your desired results, continue using sunscreen daily. And, other ingredients including alpha hydroxy acid, retinoids, botanical brighteners and Vitamin C may be continued as well for their skin benefits beyond skin lightening.