Before I was in my thirties, dark spots began to appear on my forehead and above my upper lip.
At first I thought it was just the side effects of my youth spent sunbathing. But after a visit to the dermatologist, I found out that these dark spots are actually associated with a skin condition called melasma .
Does it sound familiar to you? Well, keep reading, because in this post I’m going to tell you all about my experience with melasma.
What is melasma?
Melasma – also called chloasma or mask of pregnancy – is a change in the hyperpigmentation of the skin that appears as brown spots on the face.
They are usually symmetrical, that is, the spots appear on both sides of the face, especially on the cheeks, the bridge of the nose, the forehead and the upper lip. In rare cases, melasma can affect the forearms.
This skin condition is very common, particularly in those who have brown skin.
But while it can be quite frustrating – and can even have a negative impact on quality of life – it is not dangerous to health, and is not associated with any internal disease or organ malfunction .
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Who is affected?
The spots develop especially in people with dark skin, and 90% of the cases are women . So if you are a woman, you have brown skin, and you live in an area with a lot of sun, you are very likely to have melasma.
That is why it tends to get worse in summer.
What causes it?
Although the exact cause of its formation is unknown, it is known that many different factors can play a role.
These include genetics , sun exposure and hormonal changes – for example, the use of the contraceptive pill, or pregnancy.
Ultraviolet radiation stimulates melanocytes – the cells that make pigment – to produce more melanin – pigment.
And melanocytes are particularly active in those dark or black skin. Even small amounts of light exposure , such as when driving or walking from a parking lot to a store can cause harm , which would explain its high prevalence.
Recent studies have shown that blood vessel abnormalities within melasma spots can also contribute to excessive pigmentation.
Irritation and small skin wounds can also develop a brownish tint as they heal. Irritation can also make darkening worse.
How do I know if I have melasma?
Due to its distinctive appearance, melasma can be easily diagnosed by a dermatologist through an examination of the skin .
It appears as patches of light, medium, or even dark brown pigmentation that are visible to the naked eye; and the dermatologist can also use an ultraviolet lamp to determine the location of the pigment.
A small skin sample -biopsy- can also be taken to confirm the diagnosis and exclude other causes of increased pigmentation.
Excess melanin can be located in the superficial layers of the skin -epidermal melasma-, in the deeper layers of the skin -dermal melasma- or in both layers of the skin -mixed melasma-.
The best treatments for melasma
I’m not going to fool you, melasma is hard to treat . But in most cases it can be eliminated or, in the worst case, its tone can be blurred.
There are several treatments available for blemishes, but none works for everyone.
While some suffer from this condition for only a few weeks or months, many have it for years or decades.
Melasma associated with pregnancy usually clears up within a few months after delivery, although women living in sunny climates may have persistent pigmentation for several years.
And if hormonal factors are involved, the use of the oral contraceptive pill or intrauterine devices should be discontinued.
Because the sun and natural lighting are the main causes of melasma, the use of sunscreen is really important in any treatment plan.
It is essential to use a broad spectrum sun protection – with an SPF 30+ or higher – that protects against the UVA and UVB rays of ultraviolet light.
Sunscreen should be applied twice a day, 30 minutes before sun exposure . And physical filters like zinc oxide and titanium oxide can be put on top of chemical sunscreen to block the light even more.
If you go out, it is also recommended that you wear a wide-brimmed hat or cap and that you wear sunglasses to minimize the impact of the rays.
Daily use of sunscreen is important, as even small doses of light can make the darkening worse.
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Although there are many anti-blemish creams available for the treatment of melasma, their agents do not “whiten” the skin by destroying the melanocytes, but rather reduce their activity.
The hydroquinone is the most widely used depigmenting agent and is available in low concentrations without prescription -and either in a separate formulation or mixed with other ingredients and assets- high concentrations through the prescription of a doctor or dermatologist.
It is very effective, and in about 3-6 months you will see its good results; However, it does have some side effects, as the higher the hydroquinone concentration, the higher the incidence of irritant dermatitis -eczema-.
Therefore, hydroquinone should be used for limited periods of time under the supervision of your dermatologist.
Creams that combine tretinoin, steroids, or glycolic acid , along with hydroquinone, increase its depigmenting effect.
It may also reduce the appearance of stains counter products containing bleaching ingredients as the kojic acid , arbutin and licorice extract .
The azelaic acid and retinoids are two other agents having depigmenting effects and are effective in many cases. They can be used as a standalone treatment or in combination with other agents.
These can also cause skin irritation, so their use should be supervised by a dermatologist.
The ascorbic acid – vitamin C is sometimes used in addition to other treatments such as hydroquinone.
The chemical peels have moderate success in treating melasma. Also, multiple sessions are required to achieve good results .
The best way to use them is in combination with topical creams . Superficial peels are preferable to medium or deep peels.
The types of peels used include:
- Glycolic acid peels -the most used exfoliation-
- Lactic acid peels
- With low resistance tricholacetic acid
- Or with Retinoids
Medium or deep chemical peels should not be used to treat this problem due to the high incidence of complications.
Laser and light treatments
Laser and light-based treatments should only be used in severe cases where the therapies I mentioned above are not effective .
Why? The risk of complications is high and therefore a small trial treatment is initially performed to ensure that the pigment does not react to darkening.
It takes several sessions to see a noticeable improvement . Only certain lasers should be used and these should be used with great care, under the direction of a dermatologist.
- The 1064nm Q Switch Nd Yag laser , in low power settings, is the most promising laser treatment for blemishes to date. But it takes several sessions over many months to see improvements.
- Vascular laser treatment can be used to treat melasma if it has a red component – erythrotelengiectatic melasma subtype.
- Non-ablative fractional laser treatment is not commonly used, but is also used, especially in people with fair skin. Complications are increased if they are used in people with pigmented skin.
- The Intense Pulsed Light (IPL) may be effective in some cases of epidermal melasma in clearer skin types only.
- Fully nonablative lasers are NOT recommended for the treatment of melasma, as the risk of complications is too high.
Even so, you should bear in mind that, although the treatment is effective, the recurrence of the condition is very common.
Tranexamic acid has been reported to be a promising treatment for this condition. Currently, some dermatologists use it in pill form for melasma that has not responded to creams.
To further evaluate the efficacy of this treatment, further studies will be required at different centers.
Newer Q-Switched picosecond lasers may be more efficient than current Q-Switched nanosecond technology.
However, this will require more research before recommendations can be made for its use in treating stains.
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Makeup can hide most cases of melasma, but in some cases the pigmentation is too dark to cover it successfully.
Can melasma be removed?
It depends on what type it is . Epidermal melasma has a better prognosis than the mixed or dermal type, but all types are recurrent and require ongoing maintenance therapy.
Melasma associated with pregnancy is more likely to improve as the pigment gradually fades over the months. However, melasma often recurs in later pregnancies.
There are several cosmetic products for skin whitening and they can be effective for mild cases of melasma. There are other procedures as well, including chemical peels, microdermabrasion, and laser surgery, although their results so far have not been consistent.
Procedures like these, which remove the top layers of the skin, have the potential to cause significant irritation , which can make melasma worse.
However, if done correctly, these procedures may produce some benefit for certain people.
In summary, while melasma can be a persistent, frustrating and difficult to treat problem, a comprehensive approach that includes avoiding the sun, the use of sunscreens, depigmenting agents, occasional treatments, and close supervision by a dermatologist, it can lead to a successful result.
- Melasma: diagnosis and treatment – American Academy of Dermatology
- Melasma Treatment: An Evidence – Based Review – American Journal of Clinical Dermatology
- Topical treatment of melasma – Indian Journal of Dermatology
Kathie Sand always saw the world of beauty as the terrain on which to build her professional career, a goal that was clear to her when she was only 15 years old. Her great concern to expand knowledge led her to settle in Paris where she studied hand in hand with the best beauty professionals and with the most advanced techniques for skin care.