Melasma Treatment

What causes melasma?

The cause of melasma is not clear, but may be due to hormonal changes occurring in the body. Some factors that may influence the production of melasma include the following.

Gender

Women more commonly experience significant hormonal changes than men, particularly as they undergo pregnancy or utilise the contraceptive pill to control their ovulating cycles. Due to these changes, as well as other milestones like menopause, women are more likely than men to develop melasma.

Hormones

The hormonal factors that women experience more than men include higher levels of oestrogen and progesterone. When individuals experience a stronger influence of these hormones, it is highly likely to develop melasma in their skin.

Hormonal influences that may cause melasma include:

• Pregnancy
• Menopausal hormone therapy
• Dosage of an oral contraceptive pill containing oestrogen and progesterone
• Intrauterine implants and devices

The development of skin pigmentation is so common during pregnancy that people often refer to the skin condition as the ‘mark of pregnancy’. However, it is possible that you may not even develop melasma while pregnant.

Genetics

It is a working theory that melasma is a genetic skin condition, namely because roughly 60% of patients with melasma have a positive family history. There is no conclusive evidence as of yet.

Skin type

Due to melanin production being stimulated by UV rays, it has been noted that long-lasting hyperpigmentation is likely to be more evident in the darker skin tones that absorb it better.

Sun exposure

UV radiation may be a key factor in the formulation of melasma, and as such, those affected with melasma often first notice it appears during or after a summer when they have had significant UV exposure. 

The blue light from the sun’s visible rays is the main aggravating factor, which can be protected against with appropriate care and sun avoidance. 

Heat exposure

There is a belief that melasma can also occur through extended occupational heat exposure, or by being close to cooking fires, which causes UV light and thermal damage. Waxing can also lead to worsening of melasma, so avoid waxing areas affected by melasma.

Medications

Some ingredients found in cosmetic products or even perfumed soaps may cause a phototoxic reaction, leading to the onset of melasma.

These include:

• Antimalarial products
• Anti-epileptic products
• Antipsychotics
• Cytotoxic/Antineoplastic products

It is important to try to determine if any causative factors in your skincare products or medications may be exacerbating the pigmentation. 

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Where is melasma most common?

Each case of melasma pigmentation has its own type of distinct patterns and common manifestation sites on the body. The areas melasma is most common are:

• Centrofacial – Accounting for 50-80% of presentations and can be found on the cheeks, forehead, nose and upper lip (bar the philtrum)
• Malar – Cheeks and nose
• Mandibular – Jawline and chin
• Extra facial – Shoulders, upper arms and forearms, following the most sun-exposed areas

How to manage melasma at home

There are measures you can implement at home to help manage the appearance of melasma pigmentation. 

Sunscreen

Using sunscreen daily, irrespective of the weather or your planned (or unplanned) exposure to the sun, is very important. Daily application can protect your skin from damaging UV rays, which may prevent the onset of melasma. Broad-spectrum sunscreen is the most ideal choice to apply on the face and body.

Topical lightening agents

Topical lightening agents may help significantly lighten melasma, as well as prevent it from spreading, especially when used in conjunction with daily sunscreen.

While pigmentation skincare products with lightening agents can reduce the appearance of melasma in the skin, other specific ingredients within medical grade skincare, can also be used to help in the treatment of melasma, including:

• Vitamin C: Vitamin C is commonly used for treating epidermal melasma, as the topical application can not only protect the skin from UV rays, but also target melasma pockets. Products like vitamin C serums can be used to brighten your complexion and skin tone.
• Kojic acid: Kojic acid acts as a tyrosinase inhibitor, preventing the production of melanin.
• Hydroquinone: Especially useful for epidermal melasma, this compound can help break down the overproduction of melanin in the skin.
• Azelaic acid: A naturally occurring acid that also inhibits tyrosinase, but mainly operates to reduce free radical production in the skin that can cause melasma.
• Retinoids: An ingredient commonly seen in retinol serums and vitamin A skin care may help interrupt the melanin process and remove built-up pigmentation.
• Glycolic acid: When combined with other agents in a product, this acid directly reduces melanin formation which leads to pigmentation.

If you see these ingredients in brightening serums or pigmentation serums, they may successfully target hyperpigmented areas and reduce the appearance of brown spots. 

Oral medication

There are severe oral medications that can be used to treat melasma, like oral tranexamic acid. Traditionally, it has been used to stop bleeding, particularly during menstruation or post-dental extraction, but in smaller doses can be used to prevent the formation of melanin in response to UV radiation.

What are the risks and side effects associated with melasma treatment?

Each melasma treatment comes with its risks and side effects, which will be discussed with your practitioner before treatment begins. They will outline any potential risks that the treatment may pose, as well as provide after-care instructions to deal with any side effects that arise.

FAQs

Can melasma be removed permanently?

Most cases of melasma will fade away with time and treatment, particularly if you take care of your skin and protect it from the sun. Maintenance is required to prolong results from your initial course of treatment.

What is the difference between melasma and pigmentation?

The difference between melasma and pigmentation is the cause of the change in skin tones. Although pigmentation is sun-related, melasma often finds its cause as hormonal changes within the body, with the sun exacerbating the symptoms.

How to treat melasma on the face?

With the face being one of the areas most susceptible to pigmentation, there are several treatment options available. At-home remedies like topical lightening agents or oral medication can certainly reduce the signs of skin pigmentation. However, seeking professional help can allow for greater and long-lasting improvements.

Consultation with a practitioner can confirm the best course of action for your skin, and they can provide a proper treatment regimen to follow after your first session. By following the initial treatment with maintenance therapy, you can maintain your skin.