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What is melasma?

Melasma is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation. Melasma can also affect the arms and back. It can lead to considerable embarrassment and distress.

This form of facial pigmentation is sometimes called chloasma, but as this means green skin, the term melasma (brown skin) is preferred.

Who gets melasma?

Melasma is more common in women than in men; only 1-in-4 to 1-in-20 affected individuals are male, depending on the population studied. It generally starts between the age of 20 and 40 years, but it can begin in childhood or not until middle age.

Melasma is more common in people that tan well or have naturally brown skin (Fitzpatrick skin types 3 and 4) compared with those who have fair skin (skin types 1 and 2) or black skin (skin types 5 or 6).

What causes melasma?

The cause of melasma is complex. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes (epidermal melanosis) and deposited in the dermis (dermal melanosis, melanophages). There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people, melasma is a chronic disorder.

Known triggers for melasma include:

• Sun exposure and sun damage — this is the most important avoidable risk factor. Visible light and ultraviolet rays contribute to abnormal pigmentation
• Pregnancy — in affected women, the pigment often fades a few months after delivery
• Hormone treatments — oral contraceptive pills containing oestrogen and progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women
• Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries and cosmetics may cause a phototoxic reaction that triggers melasma, which may then persist long term
• Hypothyroidism

Melasma commonly arises in healthy, non-pregnant adults. Lifelong sun exposure causes deposition of pigment within the dermis, and this often persists long-term. Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes to produce more melanin.

Melasma commonly arises in healthy, non-pregnant adults. Lifelong sun exposure causes deposition of pigment within the dermis, and this often persists long-term. Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes to produce more melanin.

Vascular pertains to blood vessels and lymphatic vessels.

A melanocyte is a cell found in the basal layer of the epidermis that produces a protein called melanin that protects the skin from damage due to ultraviolet radiation.

What are the clinical features of melasma?

Melasma presents as macules (freckle-like spots) and larger flat brown patches. These are found on both sides of the face and have an irregular border. There are several distinct patterns.

• Centrofacial pattern: forehead, cheeks, nose and upper lips
• Malar pattern: cheeks and nose
• Lateral cheek pattern
• Mandibular pattern: jawline
• Reddened or inflamed forms of melasma (also called erythrosis pigmentosa faciei)
• Poikiloderma: reddened, photoaging changes are seen on the sides of the neck, mostly affecting patients older than 50 years
• Brachial type of melasma affecting shoulders and upper arms (also called acquired brachial cutaneous dyschromatosis).

Melasma is sometimes separated into epidermal, dermal, and mixed types. A Wood lamp that emits black light (UVA1) may be used to identify the depth of the pigment.

Epidermal melasma

• Well-defined border
• Dark brown colour
• Appears more obvious under black light
• Responds well to treatment

Dermal melasma

• Ill-defined border
• Light brown or bluish
• Unchanged under black light
• Responds poorly to treatment

Mixed melasma

• The most common type
• Combination of bluish, light and dark brown patches
• A mixed pattern is seen under black light
• Partial improvement with treatment

DEVICES THAT WE TREAT MELASMA

PICOWAY LASER - SPECTRA LASER - EDERMASTAMP MICRONEEDLING - MICRODERMABRASION

SKIN CARE FOR MELASMA

Melasma may be treated with Hydroquinone and non-Hydroquinone based skin care products. at JEUNESSE SPA AND SKIN CARE we carry 2% hydroquinone, and a variety of skin brighteners that contain Melanyzme,
Tranexamic acid, Antioxidants, Peptides, Azelaic acid, Kojic Acid, Glycolic Acid and Sun Block of SPF 50. All have been shown to be highly effective in regulating and enhancing pigmentation. 

Generally, a combination of the following measures is helpful.

Discontinue hormonal contraception.
Year-round life-long sun protection. Wear a broad-brimmed hat.
Use broad-spectrum very high protection factor (SPF 50+) sunscreen applied to the whole face daily, year-round. It should be reapplied every 2 hours if outdoors during the summer months. Sunscreens containing iron oxides are preferred, as they screen out some visible light as well as ultraviolet radiation. Alternatively or as well, use a make-up that contains sunscreen. 
Use a mild cleanser, and if the skin is dry, a light moisturiser.
Cosmetic camouflage (make-up) is invaluable to disguise the pigment.