Melasma is a prevalent condition in adults and affects both men and women, but is more common in women and also in people with darker skin types. Melasma is characterised by darker areas of pigmentation on the face and worsens in sunny climates, with the condition being more noticeable during Summer months. It is not a skin infection and is not linked to skin cancer. It is not contagious, not linked to allergy and the pigmented areas are not raised or itchy. Melasma during pregnancy is called “chloasma” and sometimes referred to as “the mask of pregnancy” as it appears as a mask over the cheeks and nose area.
Whilst the exact cause of melasma is not known, we do know that certain factors trigger or contribute to it. Melasma is often triggered during pregnancy, and also by hormonal drugs, such as the oral contraceptive pill. Melasma can also run in families but whilst it is a familial trait, it is not hereditary. Melasma can affect the epidermis, the dermis and it can also be mixed – affecting both the epidermis and deep dermis. This is what makes it difficult to treat.
Melasma typically affects the cheeks, forehead, upper lip and nose, and is often symmetrical. The cosmetic aspect usually upsets people affected by melasma and it can be difficult to hide with concealers and conventional makeup. It is made worse by sun exposure and sunbeds, so this should be avoided wherever possible. Melasma is distressing for people as it does not usually disappear by itself and is a permanent issue.
There is no cure but there are ways of treating the pigmentation and lightening it. Superficial pigmentation is easier to treat than deep pigmentation. If melasma occurs during pregnancy, it may resolve on its own within a few months after delivery and treatment may not be necessary.
Tips for melasma sufferers
- most importantly – avoid UV exposure, so no sun and no sunbeds
- use a sunscreen daily that protects you against UVA and UVB and is a minimum of SPF30 – look for the UVA 5 stars on your sunscreen
- wear a hat and sunglasses when outdoors
- avoid triggers such as oral contraceptive pill
Treatment for melasma
Certain chemicals can reduce the activity of pigment-forming cells in the skin, and of these, hydroquinone is the most commonly used. Hydroquinone creams may cause irritation, and care must be taken to ensure that they are not used for too long in case they cause excessive skin lightening. Prolonged use of Hydroquinone can occasionally cause increased darkening of the skin, especially in dark-skinned people. Hydroquinone is a prescription only medicine.
Azelaic acid and retinoid creams that are used to treat acne can also help melasma. Vitamin A retinoids, such as tretinoin (prescription medicine) and Retinol help by increasing cell turnover to aid removal of damaged skin. They also help to regulate oil production, which also helps with excess pigmentation.
All these creams can irritate the skin and are therefore sometimes combined with steroid creams. Some skin bleaching creams, such as Pigmanorm Cream contain a mixture of these ingredients.
Chemical peels or laser treatment may improve epidermal melasma by removing the outermost cells of the skin that contain the excess pigment. They are not effective on dermal (deeper) melasma. Laser treatment may not be safe on darker skin types, and may increase the risk of worsening of the condition.
We also recommend the Obagi Nu-Derm Medical system – this is a complete skincare regime that will transform skin and is usually successful for melasma sufferers. After an initial period on the Obagi Nu-Derm Skincare System, there is an option for adding in a medium-depth peel to accelerate results.