Melasma: what is it and how to treat it?
Melasma is hyperpigmentation in the face that causes brown spots (melanosis faciei). It usually occurs in women, but does not completely leave out men either. Melasma often occurs during a woman's fertile period and especially during pregnancy. Pigmentation that occurs during pregnancy is also called pregnancy mask. Melasma can be recognised by an erratic pattern of blotchy hyperpigmentations of the skin. These spots are especially visible on the forehead, cheeks, around the eyes and upper lip.
Melasma can be frustrating. The brown spots often appear without warning and are difficult to combat. Often, just when you feel it is easing, they come back rock hard. With melasma, therefore, prevention is better than cure. Know what your triggers are and how to prevent the pigmentation from flaring up. Unfortunately, there is no quick fix, but there are effective melasma treatments and things you need to know to avoid accidentally making it worse.
Melasma and hyperpigmentation: what's the difference?
Simply put, melasma is a form of hyperpigmentation. Hyperpigmentation is a term that refers to a part of the skin that is darker than the rest. Hyperpigmentation can result from sun damage, injury, acne, skin care products or cosmetic procedures such as lasers. Anything that inflames the skin can cause hyperpigmentation. But while all melasma is hyperpigmentation, not all hyperpigmentation is melasma. The skin can develop hyperpigmentation due to wounds from within such as cystic acne and eczema. In that case, you are more likely to speak of post inflammatory hyperpigmentation, as it is a clear reaction to inflammation and skin damage.
Melasma, on the other hand, is often hormone-dependent or genetically determined. Also, melasma is not expressed in the same way. Melasma often looks blotchy and is often more widely spread across the face.
What causes melasma?
If you suffer from this form of hyperpigmentation, you've probably heard the standard drill many times: genetic predisposition, female hormones or pregnancy, contraceptive use, hormone therapy and exposure to UV radiation.
Genetically, melasma mainly affects people of colour, whose melanocytes, the pigment-producing cells, are more active. Those with medium skin colour, skin types III and IV, tend to be the hardest hit. But, that certainly does not make the other skin types immune, especially when sunlight and oestrogen are involved.
Sunlight structurally alters epidermal and pigment cells and chemically alters the melanin already in your skin. When the sun stimulates your cells to make extra melanin, this boost causes skin cells to produce more melanocytes. Thus, even more pigment is produced, which can give you large, dark spots.
The relationship between hormones and melasma is complex. It seems that oestrogen is the main hormonal culprit. Because our melanocytes have their own oestrogen receptors, they are prompted to produce more pigment when hormones are circulating in the body. Precisely because oestrogen seems to play a role, women suffer from melasma more often than men.
Prevention is better
Preventing melasma is always better than trying to treat it once it has flared up. These things you can already do yourself to prevent your melasma from getting worse.
Visible light
Visible light can stimulate enzymes involved in the melanin production process. These include sunlight, light from appliances and (incandescent) lamps. Tricky, then, to avoid completely. But, the higher the dose of visible light our skin receives, the darker the skin becomes. Because pigmentation caused by visible light tends to be darker and last longer compared to UV-induced pigmentation, it can be an important factor when trying to improve melasma. Sunscreens that contain iron oxides can absorb visible light and provide some protection.
Heat
What we feel as heat is actually the infrared energy given off by the sun, fire, radiators and even our own skin. Heat dilates the veins, causing blood vessels to open more and flow more freely. This can make us more receptive to cellular stimulators of pigmentation. Heat can further fuel inflammation, further stimulating pigment production. So always keep the necessary distance from extreme heat sources. During exercise, you can pay extra attention to your body temperature: drink ice water, stay near air conditioning and finish with a cold shower if necessary. In this way, you will help the blood vessels to constrict quickly after your workout.
Irritation
Masks, eczema, retinoids, waxing: anything that causes injury or irritation to the epidermis can cause or worsen melasma. If you have melasma, you will probably have already noticed that some areas darken if they have been exposed to irritation or damage. If you are prone to melasma and still develop rashes or irritation, you can ask your treating doctor for a cortisone prescription or soothing cream. In fact, if you don't treat the irritation quickly, you may develop pigmentation that lasts much longer. Preventing irritation is always better, of course. At night, fortify your skin's moisture barrier with creams rich in lipids, cholesterol and fatty acids. Our favourite: SkinCeutical Triple Lipid Restore.
What are the best melasma treatments?
Melasma is very difficult to treat and cannot be completely cured. But, there are topical treatments that work well for most people. However, patience, discipline and consistency are essential for proper treatment of melasma.
Chemical peelings
If you want to treat melasma with a chemic peel, it is important to have such treatment done by an experienced specialist. This is because a peel that is too strong and not suitable for your skin type can only worsen melasma. Most specialists will start with a lower strength and gradually increase, as they can assess how the skin reacts.
A good peel is twofold, suppressing melanin production to prevent more pigmentation on the one hand, and stimulating cell renewal to minimise existing pigment that is already visible on the other. A common peel for melasma that does both is the Mela Peel Forte by Dermaceutic. This peeling regulates the pigmentation process in the skin and helps the top layer of skin, where the pigment is mainly located, to flake off at an accelerated rate. The peeling contains arbutin, kojic acid, phytic acid, retinol, salicylic acid and lactic acid. These ingredients inhibit the formation of enzymes like tyrosinase, which are involved in pigment formation in the skin. Eventually, the pigment cells can form less pigment, making melasma less visible. These ingredients inhibit the formation of tyrosinase. This is an enzyme involved in the formation of pigment in the skin. This allows the pigment cells to form less pigment.
Lasers and IPL
In laser treatments for melasma, extreme caution is required. Whereas lasers that work well for other forms of hyperpigmentation, in the case of melasma they can only worsen the problems. Some lasers cause inflammation or skin damage that in turn trigger hyperpigmentation. Melasma can be deeper or more superficial, and these very different depths react differently to different lasers. If you do consider laser treatment, always seek a qualified professional for your treatment.
In brief: the do's and don'ts:
- Use a good blocking sunscreen every day, even when it rains and even if you stay indoors.
- Avoid sun exposure as much as possible.
- If possible, avoid contraceptive methods with hormones.
- Use pigment-inhibiting skincare products.
- Avoid extreme heat such as a sauna.
- Avoid infrared heat.
- Avoid cosmetic treatments that cause inflammation.
- Always consult a qualified specialist for tailored advice.