What is Melasma?
Melasma is chronic skin condition that presents as a bilateral, blotchy, brownish facial pigmentation. It is also known as the “mask of pregnancy”
Who gets melasma?
Melasma is more common in women with an onset typically between the ages of 20 and 40 years. Melasma is most common in people who tan easily or have naturally olive/brown skin. It is less common in people with fair skin or dark skin.
What causes melasma?
The cause of melasma is complex. It has been proposed to be a photoaging disorder in genetically predisposed individuals. Family history, sun exposure, pregnancy, thyroid disorders, hormonal contraceptives, hormone replacement therapy , scented products, perfumes, skin irritants and heat can worsen melasma
What does melasma look like?
Bilateral, asymptomatic, light to dark brown patches with irregular borders. Pigmentation can be in epidermal and/or dermal layer of skin.
#Epidermal melasma (superficial)
Difficult to treat but can see some improvement with a good skin care plan. Well defined border with darker brown colour. Top layer of the skin pigmentation will look more obvious in skinscope.
#Dermal melasma (deep)
Can be challenging to treat, with often limited improvement. However, we can focus on maintenance to prevent further pigmentation. Ill-defined border of light brown/blue-grey tone. Does not “light up” in skinscope.
What is the treatment for melasma?
- Year-round, life -long sun protection, use broad spectrum sunscreen. Discontinue hormonal contraception if possible
- Topical therapy
- Short term prescription kligmans cream (hydroquinone, tretinoin, topical steroid. Risk ochronosis), prescription azelaic acid, prescription methimazole cream
- Reduce pigment production: hydroquinone, retinoid, azelaic acid, kojic acid, cysteamine cream, vitamin C, tranexamic acid, glutathione, soybean extract, arbutin, niacinamide, green tea, liquorice root, silymarin
- Reduce pigment transfer: niacinamide, retinoids, soy
- Increase skin turnover: AHA, BHA, retinoids
- Oral treatment/ supplement
- Tranexamic acid can be used for non-smokers, who do not have a family history of clots- a prescription is required for this.
- Melatonin 3mg at night
- Polypodium leucotomos twice a day
- In clinic treatment
- Chemical peel: superficial pigment can be peeled off using AHA, glycolic acid, BHA
- Microneedling
- Tranexamic acid intradermal injection
- Laser (QS/PICO) by skilled operator
- I recommend against IPL in melasma, it looks great initially, but comes back with a vengeance