Top 4 Treatment Options for Melasma

Top 4 Treatment Options for Melasma

Pamela Bandelaria |Jun 8, 2022

What is Melasma?

As early as 470 to 360 BC, during the time of Hippocrates, skin discoloration worsening after sun exposure and heat was discovered. Eventually, this skin condition was named chloasma and what we now commonly know as melasma. So, what is melasma?

Although it is not life-threatening, melasma can have an impact on a person’s physical appearance, leading to psychosocial and emotional distress. This can affect a person’s quality of life, self-esteem and wellbeing. This article will discuss what melasma is, what causes it and its common symptoms. We will also outline the top treatments for melasma and how it can be prevented.

Melasma Explained

Melasma is an acquired skin condition characterized by increased pigmentation in the face (hyperpigmentation). Melasma usually occurs more often in females and in people with darker skin. In America, it is common among people residing in the intertropical areas where there is greater exposure to ultraviolet radiation. Melasma usually appears between the age group of 20 to 40 years old, especially among females in their reproductive years. It is rarely seen before puberty.

What Causes Melasma?

The exact cause of melasma is unknown, but throughout the years, factors that trigger melasma have been identified. The main triggers are usually radiation and hormones.

Radiation, whether ultraviolet light, visible light, or infrared light can cause melasma. Sunlight exposure makes it worse and is the most important trigger. People who are exposed to ultraviolet radiation have an increased risk for developing melasma.

Furthermore, because it is affected by hormones, there is an increased risk for melasma during pregnancy. Around 50% to 70% of pregnant people report having it. People who take oral contraceptives or people who undergo hormonal therapy also have a higher risk for melasma.

Other risk factors include stress and exposure to certain cosmetics or medications (such as some anti-seizure and phototoxic medications). A family history of can also increase the chances of someone having this condition by 50%.

The exact cause of hyperpigmentation is still being studied, but it is observed that the effect leads to skin cells (melanocytes) being stimulated by hormones (estrogen or progesterone), which leads to the increased production of melanin pigments that cause hyperpigmentation. This is further exacerbated when exposed to radiation, such as being under the sun for significant periods of time. UV exposure is said to directly stimulate the activity of melanocytes, leading to increased pigmentation.

What Are the Symptoms?

It is characterized by hyperpigmentation. The hyperpigmentation is symmetric and presents as brown or grey patches. These patches usually have irregular contours. The patches are usually seen in various areas of the skin but especially in the sun-exposed areas, such as the face and neck. In Around 50% to 80% of cases of melasma, the hyperpigmentation is in the central facial area, which includes the forehead, upper lip and nose. There are cases wherein the area of the cheeks is affected and in a smaller group of people, the jawline and chin are affected.

What Are the Treatment Options?

Although melasma is a common disorder, management of the condition can still be difficult due to the recurrence rates and limited knowledge of disease progression. However, the treatment of melasma can be grouped into topical, oral and procedural therapies. These will be discussed below.

1. Avoiding Triggers

The best treatment for melasma is combining topical treatments while also avoiding triggers, such as sun or estrogen exposure. Because the sun is the most common trigger, avoiding sun exposure can do a lot in preventing melasma. Avoiding triggers can already have a big impact and can prevent a person from spending too much on expensive medications and treatments. Avoiding triggers also has a big effect on reducing recurrence rates.

People with or at high risk for developing melasma should avoid using too many cosmetics, especially if your skin is sensitive. Vigorous rubbing of cosmetic creams and other agents on hyperpigmented skin may worsen the condition.

Other than avoiding the sun, skin protection from sunburn is also important. The use of high SPF sunscreens (SPF of at least 50 or higher) can also prevent the development of melasma. When it is unavoidable to go out, wearing protection, such as hats or bringing an umbrella, can also help.

2. Topical Therapy

The first therapy option for melasma is topical therapy. Topical therapy includes a combination of hydroquinone, tretinoin and corticosteroids (commonly the corticosteroid fluocinolone acetonide is used). When a person has hypersensitivity to triple combinations or when they are unavailable, dual ingredients or single topical agents are given. The triple combination topical therapy is currently the treatment that is most effective and favorable. Topical bleaching creams can also be helpful, but results are not guaranteed and sometimes effects take too long and are minimal.

3. Oral Therapy

Usual oral therapies include tranexamic acid, glutathione and polypodium leucotomos. These oral therapies can help reduce symptoms. However, in terms of effectiveness, oral therapy shows various results in the resolution of melasma, thus they are usually used if topical therapy is unavailable or cannot be given. Although oral therapies are not the first option or standard of care for melasma at present, various studies show that they have promising results.

4. Procedural Therapy

Usual procedures to treat melasma include chemical peels, micro-needling, radiofrequency and lasers. Effectivity of procedures to treat melasma is mixed and can vary from person to person. In some cases, chemical peels and lasers can yield faster results compared to topical medications. However, there is no guarantee of the resolution from these treatments. Furthermore, these procedures may have adverse effects, such as skin damage, further hyperpigmentation due to inflammation and scarring. Lasers have also been found to be associated with increased recurrence rates. This is why these are usually used as adjuncts or second line therapies if other treatments are unavailable or have failed.

In Review

This condition is managed using one or more therapies. A combination of any of these treatments usually provides better results than using one type of treatment only. In some cases, it can even resolve on its own, especially if triggers are avoided.

Although melasma may not be life-threatening, its impact on appearance can be significant. Even if the primary reason for the treatment is aesthetic, its effect on a person’s confidence and self-esteem is irreplaceable.

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