What is the best treatment for melasma - MY BLOGS

How To Treat MELASMA At Home.

Melasma is a skin condition that causes patches and spots on the face which are darker than your natural skin tone most people get it on their cheeks, chin, nose bridge, forehead, and above the upper lip.

It sometimes affects your arms, neck, and back, also in fact melasma can affect any part of your skin that is exposed to sunlight.

That's why most people with melasma notice that their symptoms worsen during the summer months.

Melasma is a very common skin disorder and the condition is much more common in females than men although men can develop it too according to the American academy of dermatology 90 percent of the people who develop melasma are females.

It’s also called “chloasma” when it occurs in pregnant females.

The word chloasma basically means the mask of pregnancy.

The word melasma comes from the Greek word milas which basically means black.

It is not an infection therefore it is not contagious meaning it does not spread from one person to another it is also not due to an allergy and certainly not a pre-malignant condition.

Melasma is more common in people of color and those who tan very quickly but can occur to anyone it may occur in any population but it is more common in Asian Middle Eastern Mediterranean African and Brazilian populations.

Now let's talk about what is the reason behind melisma.

This is a cross section of the skin which shows skin cells arranged in different layers among these skin cells you can clearly see a large pigment producing cell that is known as a melanocyte these melanocytes have finger like projections known as dendrites.

Which extend all over the skin so that the pigment produced can be evenly distributed to the skin. 

Melasma develops due to the over production of melanin by these cells due to certain factors like excess sunlight.

Exposure the melanocytes become hyperactive and start producing excessive melanin this causes the development of dark patches of skin on your face or anywhere else on the body genetic predisposition.

Exposure to sunlight including ultraviolet rays skin type hormonal factors including pregnancy hormonal therapies and the use of oral contraceptives are the main risk for the triggers of melasma.

Additional factors associated with the development of melasma also include some cosmetic usage intake of certain medicines like photosensitizing and anti-epileptic drugs can cause melasma.

Several studies suggest that melasma can also be associated with zinc deficiency and abnormal thyroid function.

How does melasma present?

Change in skin color is the only symptom of melasma the brown patches don't hurt itch or physically affect you the patches are usually an even brown to gray brown in color and are usually symmetrical.

Facial patterns of melasma;

There are some patterns in which melasma occurs common facial patterns of distribution for melasma include the Centro facial pattern the malar pattern and the mandibular pattern.

• The Centro facial pattern commonly affects the central part of the face including the forehead cheeks nose upper lip and the chin area.

• Then we have the malar pattern which predominantly involves the lateral cheek areas.

• We also have the mandibular pattern which affects the lower jawline so, now we have a brief knowledge of what melasma is and how it presents let's talk about the psychological impact of melasma.

Psychological impacts of melasma;

Multiple studies have documented the detrimental and psychologically devastating effects that melasma has on quality of life.

A study of 140 individuals with melasma from India found that 75 percent of these people were bothered or frustrated by the disease most or all of the time.

42 of these patients reported that melasma was associated with depression embarrassment and had a negative impact on relationships with other people.

The psychological problems can impact young and old patients alike but the studies point out that the quality of life was worse in unmarried female patients with melasma.

Diagnosing Melasma;

 

Melasma is generally diagnosed based on a clinical presentation or using a special lamp known as the woods lamp.

That uses ultraviolet light for a closer examination of the skin and classifies melasma as epidermal dermal or mixed depending upon the location of melanin in the skin.

In some rare cases where there is a confusion your doctor can ask for a skin biopsy which is very small piece of your skin is taken to make sure that the brown patches are indeed melasma.

Management Of Melasma;

1. Management is challenging
2. Consistency in treatment is important
3. Otherwise “Relapses” are common
4. Patient education & counseling 
5. Avoidance of risk factors & triggers
6. Strict sun protection
7. key to successful management of melasma.

The management of melasma is often challenging with incomplete responses in many cases and frequent relapses.

Patients must adopt to a consistent treatment regime to avoid relapses.

Patient education and counseling about avoidance of triggers and risk factors for melasma and the importance of strict sun protection during and after treatment is the key to successful management of melasma.

 Photoprotection.

• Sunscreen prevent worsening of hyperpigmented melasma patches

• SPF rating > 30

• Higher SPF rating better photo-protection

• Photo-protection also helps other medicines uses in the treatment to be more effective 

Photo protection is an essential component of melasma treatment.

One of the most important things you can do to prevent melasma worsening is by protecting yourself from uva radiation.

This means avoiding the sun wearing white brimmed hat when you are outside and wearing broad spectrum sunscreen since uv rays are well known trigger for melasma and can make hyper pigmented patches even more dark wearing sunscreen can help prevent.

melasma from flaring up and hyperpigmentation from getting worse the sunscreen should have an spf rating of 30 or above with a high uva rating.

The higher the spf rating the more effective the sunscreen will be protecting your skin from the sun will also help the medicines used in the treatment of melasma to have more effectiveness since sunscreens and photo protection.

Now let's look at some of the topical medications that are used in the treatment of melasma.

For patients with mild melasma doctors suggest using skin lightening creams as the first line therapy.

Skin lightening agents can be basically divided into two main types those that contain hydroquinone and those which do not contain hydroquinone.

Hydroquinone four percent cream can be applied to the affected areas once or twice daily for 2 to 4 months and can be extended up to six months.

Hydroquinone works by inhibiting an enzyme that is required in the synthesis of melanin.

Non-hydroquinone skin lighteners include azaleic acid, kojic acid, and niacinamide.

They can be used alone or in combination with hydroquinone as alternative first line therapies.

Particularly in patients who do not tolerate or have a demonstrated allergy to hydroquinone.

For patients with moderate to severe melasma triple combination cream is used which contains flucinolone hydroquinone and tretinoin.

Flucine alone is a very mild steroid and tritinoid is a derivative of vitamin A the cream is applied nightly for 2 to 4 months.

It may take several weeks before you see the results of this treatment so it's important to follow your doctor's recommendation even if you haven't seen any improvement yet.

You should keep treating your skin even after your melasma goes away.

This will help to prevent a relapse it is also important to avoid excessive sun exposure and to use a good sunscreen daily this will also help to prevent melasma from returning. 

Now let's talk briefly about the role of antioxidants in the treatment of melasma.

 Role of antioxidants in the treatment of melasma;

A randomized double-blinded study was done by Ahmad at all on 66 Hispanic females with melasma to study the role of antioxidants in the treatment of melasma.

The females were divided into two groups of 33 females each in the first study group the females were only advised to use sunscreen two times a day and in the second group in addition to applying sunscreen the females were also given polypodium leukotomos extract which is an oral antioxidant.

After a course of 12 weeks the group with oral poly podium leukotomus extract resulted in a 28.8 improvement and the group that simply used the sunscreen resulted in only 13.8 percent improvement in the melanin index.

This shows that antioxidants can also have a positive effect in the treatment of melasma.

Now if the creams are not effective in the treatment of melasma the second line treatment is used which includes chemical peels in this procedure we use products such as glycolic acid, salicylic acid, trichloroacetic acid, or jester's peel.

Chemical peels can improve melasma by removing the outermost cells of the skin that contain the pigment.

Glycolic acid peel is done in a dermatologist's office and it is a quick and effective way to rejuvenate the skin.

Dermatologists use a 30 to 40 percent concentration of glycolic acid and it stays on your skin for only two to three minutes after which it is washed away.

Chemical peels should be performed by an experienced practitioner only as inappropriate peels could make the pigmentation worse lighten the skin too much or cause scarring.

Superficial chemical peels are a treatment option for patients with melasma that do not respond to topical therapies alone.

While the term peel makes the treatment sound quite harsh it's quite gentle actually you'll feel some tingling but there's no burning redness or discomfort.

For the next five to seven days make sure to treat the skin gently do not use any exfoliation products or devices and it's very important that you use protection against UV exposure as the skin becomes very sensitive after a chemical peel.

Laser and light therapy; 

Lasers and light therapies are the third line treatments for melasma appropriate for patients in whom topical treatments and often chemical peels have failed to produce adequate improvement they should be used with great care and caution particularly in patients with darker skin to minimize the risk of post inflammatory hyperpigmentation.

Some types of lasers remove the outer layer of skin whereas others target the pigment producing cells in the skin the melanocytes.

Various types of lasers are used in the treatment of melasma like fractional lasers q-switched ND YAG lasers and IPL lasers also known as intense pulse light laser.

The success of laser therapy is variable and there may be risks associated with the treatment similar to those above.

Maintenance Therapy & Prevention of Relapse;

A Routine approaches for prevention of relapse involve the aggressive use of broad spectrum sunscreens as well as protection from the excessive sun exposure by using appropriate measures despite this approach with the availability of various.

Treatment options relapses are common relapses require resuming active maintenance treatment with azaleic acid, kojic acid, niacinamides, and retinoids.