Melasma is a common skin problem that occurs when there is overstimulation to the melanocyte (melanin producing cell) producing excess pigment and then deposition of the pigment into neighbouring skin cells (keratinocytes) resulting in dark brown patches of skin.
Factors that can stimulate the melanocytes into “overdrive mode” include genetic predisposition, sun exposure, hormonal changes such as female hormone stimulation, medication, contraception and hypothyroidism.
Melasma often has symmetrical disposition and irregular borders. It can be classified as either epidermal (and therefore should respond better to topical depigmenting products) or dermal (considered highly challenging to treat and is susceptible to constant relapses).
Melasma is notoriously difficult to treat, and if the “internal factors” causing the pigmentation are not addressed properly it can remain. Melasma can only be managed and not completely eliminated, because once the DNA of these cells is damaged they are damaged forever and melanocytes are well known for having excellent cellular memory. This is the reason why pigment rebounding is extremely common.
The first step when dealing with this condition is to block light, penetrating the skin. This is crucial to treating and preventing further darkening of melasma. Applying a broad spectrum, physical sunscreen with a high SPF each and every day is essential. Also incorporating a vitamin C serum in the morning underneath the sun cream protection helps to lighten pigment and provide an antioxidant effect.
Retinol (vitamin A) or any form of acid such as azelaic acid, kojic acid, lactic acid, mandelic acid, ascorbic acid and arbutin can assist in cell turnover and sloughing away unwanted pigment. It should only be used at night and very carefully. Over treatment or aggressive exfoliation can worsen the existing condition. If inflammation occurs this can exacerbate the melanogenesis process (pigment production within the melanocyte).
Traditional bleaching creams with hydroquinone and steroids are often prescribed, however, these formulas are not ideal for long term use and can cause side effects such as sensitivity, irritation, thinning of the skin and in some cases rebound pigment. Some products may produce initial results, however, upon longer term use the melanocytes can be damaged permanently.
Chemical peels and laser therapy can also be used to treat this condition. Specific lasers with specific settings need to be used by a trained doctor to avoid further complications or worsening of the condition.