- Melasma is a problem of hyper-pigmentation,
which mainly affects women,
because it's driven by the hormone estrogen,
as well as UV radiation.
And it affects a lot of women, especially
who have olive or darker skins,
and primarily it looks like patchy, dark pigmentation
around the cheeks, upper lip,
which can be pretty distressing for a lot of women,
as well between the brows and the forehead.
Melasma typically only affects the face,
and it can be distinguished from other
forms of pigmentation by its nature.
So it basically looks like a
slightly asymmetrical pattern
and it's confluent in some areas.
It's sort of a more patchy type of pigmentation,
and it's a very, very difficult pigmentation to treat.
It's almost impossible to cure yourself of melasma,
and I think that's a very important thing
I try to explain to all my patients.
We see it a lot in people with skin types,
what we call Fitzpatrick 4-6, which basically means
people who have olive to dark skin,
but it does occasionally occur
in people with fair skins, but not so much.
Typical nationalities we see with melasma
are sort of Asian, European, Indian,
you now, those sort of races are the most common.
Melasma is particularly hard to treat because it's
influenced by the hormone estrogen, so
females obviously have that circulating around naturally,
and the other thing is, you know, a lot of females
take the pill, which also is an external form of estrogen.
So this can also exacerbate melasma.
So the first step would be,
to address any of those issues,
which would be to maybe try a different brand of pill
or, per se a low-dose estrogen pill,
or progesterone-only pill, or some
other alternative forms of contraception.
We all are exposed to the sun, but in those with melasma,
we have to be particularly careful
of avoiding sun on the face.
We generally have a high SPF sunscreens that we recommend.
However, the most important part is to be consistent
I think, you know, to put it on every day, even if it's
raining or it's not really sunny.
If you have melasma, you really need to put it on every day,
and that's not just going to be good for your pigmentation,
but also good for anti-aging.
And the other thing with sunscreen, is to make sure
you put on a couple of layers, so it's not just
putting on one layer.
It's like painting a wall.
You paint it once, and there's always a few spots
which you've missed, so you put another layer on.
We use serums or creams that contain substances
which block tyrosinase, which basically means that
it's blocking the production of new melanin.
We have things like hydroquinone
or things like Kligman's Formula,
we also have a cream, which we like, called Lytera
by SkinMedica, which is excellent for blocking
that first step, just stopping that enzyme
which produces melanin.
The next step is to flush out
what you have,
so it's no good just blocking, you know,
tyrosinase
but you also need, and melanin production,
but you also need to, sort of turn over the skin
and really get rid of the pigment that's there.
That can be done a couple of ways.
The most common ways we do it, really, is, you know,
to use a vitamin A or topical retinoid.
So, retinoids are, you know, one of the few
creams that are proven not only to, you know,
reduce wrinkles but they also do this
by turning over the skin.
So, if there's a lot of skin turnover,
your skin is acting like a younger skin.
For those with melasma, it's great because you're
turning over that melanin in the melasma,
you're turning out that, getting rid of that pigment.
The other ways you can turn over skin,
or flush out existing melanin, is with laser.
And laser is a double-edged sword with melasma,
so we use it very, very carefully.
The importance of that is also that most
of the patients we treat with melasma
are those with olive or darker skin tones,
which generally are much more difficult to treat with laser,
'cause we have a lot of competing melanin,
naturally found in the normal skin.
So, with laser, we generally, the rule of thumb is to use
very, very light treatments and, you know, we don't
want to flare up the pigmentation.
And generally we use Q-switched Nd:YAG lasers,
sometimes we use other lasers, like the Fraxel, but
most of the time we would use the Q-switched Nd:YAG
lasers, which are
lasers which are very short pulses and they basically,
literally, go in there and break down the pigment
and cause a bit of of skin turnover.
The other thing you can do for melasma is, you can
have the occasional light peel.
Chemical peel, that is.
So, again, you have to follow same principles if you
don't want to traumatize the skin and make things worse.
So, generally the peels we use for melasma are things
like lactic acid peels, or something that, you know,
can be tolerated by any skin type.
And, again, that exfoliates the skin,
helps flush out any excess melanin
or pigmentation that's unwanted.
Finally, the other treatments we can use for melasma
are things we can use to treat melasma from the inside, out.
So, these include medications, which are
very effective, such as tranexamic acid.
We use it in very, very small doses,
twice a day
and basically this
helps to block the production
of melanin in response to UV radiations.
So, we find this to be one of the most effective treatments.
The other modality of treating the skin pigmentation
of melasma, is also to use intravenous
vitamin C and glutathione.
So, we've often treated people
using this method.
The downside is having to come in every week to have
a session of intravenous therapy,
but the upside is it does actually really brighten the skin
as well as lighten the skin, so you get
total skin lightening and also improvements in pigmentation.
In conclusion, melasma affects a lot of our patients,
especially our female patients, and it can be quite
devastating for them to have this pigmentation,
which they constantly have to cover or avoid,
you know, avoid going out without makeup,
and we find that we can really put a lid on it
and, you know, get it down to a level
which is acceptable to them, where they feel
more confident and comfortable in their skin.
It makes a big difference to those who have it.
It can be a life-changing thing to have this
reduced for them.
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