Is Your Skin Discoloured From The Sun?
It May Be Melasma

Melasma, also known as the mask of pregnancy or cholasma, is a common disorder of hyper pigmentation, often difficult to treat and predisposed to recurrence.

 

PREDISPOSING FACTORS

 

• Most common in women between 20-40 years of age
• Rare in men
• Darker skin types are more prone to melasma due to ethnic predisposition
• Common in African Americans, South Asians and Orientals as well
• Hormonal influences are thought to play an important role, such that it has a tendency to exacerbate with pregnancy, birth control pills, as well as in Peri menopause and Menopause
• Exacerbated by sun exposure and tends to be more of a problem in the spring and summer
• Melasma can be particularly troublesome for people in the service industry since the pigmentation of the skin can make the face appear dull and lack lustre.

 

Other causes of Melasma

• Liver disease
• Cosmetics
• Medication
• Nutritional deficiency
• Beta carotene

 

DISTRIBUTION

Melasma usually causes three different patterns of symmetrical pigmentation on the face.

Central face

Cheeks, forehead, upper lip, nose and chin.

Mid face

Less commonly the cheeks and nose.

Jaw line

The cheeks and jaw line. Melasma also can cause patches of pigmentation on the forearms, but this is rare.

There is no special diet, health food, vitamin, or "magic lotion" which is useful for the treatment of melasma or other forms of facial pigmentation, so spending time and money on these things will not provide desired results.

TREATMENT

Treatment is difficult; however, a number of modalities are available for controlling the pigmentation, sometimes with dramatic results.

Bleaching creams

Most skin lightening systems are composed of a set of topical aimed at cleansing, exfoliating and lightening skin.

A number of bleaching creams are available by prescription only. Our skin care specialists have had success with Triluma cream (compounded by a local pharmacist) consisting of hydroquinone, retinoic acid and a steroid at Afterglow skin and laser centre.

In the initial 8-week study, 29% of patients experienced complete clearing of melasma by week 8, and 71% were clear or almost clear by week 8. Similarly, good results were seen in the two long-term studies, with the clear/mild rate ranging from 78% to 84% of patients at month 6 and from 81% to 94% of patients at month 12. Adverse events were almost always mild in severity and typically occurred only at the application site. The primary concern for most physicians using corticosteroid-containing products on the face is skin atrophy. However, only two cases of skin atrophy were reported across the three published studies. Overall, the results of these extensive studies indicate that triple combination cream is effective in treating melasma and exhibits a safe profile with low potential for adverse events.

Lumixil

Lumixil, an amino acid in combination with licorice and a fruit extract, works by inhibiting an enzyme called tyrosine in the skin that begins the process of making melanin in the skin.

Other lightening alternatives

• Kojic acid
• Azelaic acid
• Glycolic acid

These skin care treatments have a weak effect on pigmentation and often have to be used in high concentrations to produce visible results, producing greater irritation.

Natural compounds

• Bearberry extract
• Mulberry extract
• Licorice extract
• Vitamin C
• Niacinamide

Fractional Laser And Intense Pulse Light

Melasma can often dramatically improve with a series of Fractional laser and intense pulsed light treatments spaced 1 month apart. Treatments should be medically supervised in a skin care facility that is familiar with the treatment of melasma and other disorders of hyper pigmentation.

Sunscreens

Judicious use of broad spectrum sunscreens, with a high SPF of 60 applied every 2 hours, and continued long-term reduces the risk of relapse of melasma.

CONCLUSION

Melasma, also known as the 'mask of pregnancy', is an acquired brown pigmentation, usually on the face.

No single pigment disturbance has proven more elusive to treatment than melasma.

Although melasma continues to defy simple etiological explanation, it is clearly under the control of raccial, genetic, pharmacological and environmental factors. Sun exposure, pregnancy and oral contraceptive pills have all been associated with its presentations.

Most patients seeking related skin care treatments have exhausted current options, such as bleaching, Retin A and Azelaic acid, Chemicalpeels, lasers and phototherapy.

Results in melasma treated with fractional resurfacing have been uniformly positive with modest to marked improvement in most patients. Although it is clear that fractional resurfacing does not cure melasma, it can improve it to a degree that can be maintained by standard bleaching programs and complete UVA/UVB sunscreens, which are essential components of skin care therapy.

For further information and to book an appointment for complimentary skin care consultation, please call Dr. Shehla Ebrahim at 604 980 3993 or email us at info@afterglowskincare.ca.