Melasma, also known as hormonal pigmentation, is a considerable problem for South African women. It is a chronic skin condition that occurs on the face in the form of brown patches and is a dynamic (active) condition that needs lifelong management.
What causes Hormonal Pigmentation / Melasma?
- UVA rays are a stimulant for melanin (brown pigmentation) to develop on the skin, and unfortunately can even penetrate through car window glass.
- Any change in hormonal status with higher levels of estrogen is thought to trigger and aggravate the condition (i.e. birth control pills and pregnancy). Discontinuing the use of contraceptives rarely clears the pigmentation and it may last for many years after discontinuation.
- After pregnancy Melasma (chloasma) or pigmentation usually clears within a few months of delivery but may persist indefinitely.
- However many women without these risk factors also develop melasma.
- Any activities that cause Intense heat to the face (from steam showers, hot closed environments, sitting on the beach even under cover and with full sun protection, etc causes inflammation which is a powerful stimulator of melanin.
- It is more prevalent in darker-complexioned individuals though persons of any race can be affected due to the intense sun exposure in South Africa.
- Melasma is seen most frequently in young women but can be seen in men.
Where does Melasma appear on the face?
- Centro Facial (forehead).
- Malar (cheekbones).
- Mandibular (jawline).
How can one prevent Melasma from forming?
- Avoid sun exposure and wear a protective hat when outdoors for extended periods to further block these rays.
- Use a broad-spectrum sunscreen with SPF 30+ to block the UVA rays every day to help prevent melasma.
- In addition your sunscreen should also contain an anti oxidant as this stops free radicals which cause pigmentation.
- At least 5 mls of sunscreen should be applied daily to the face and neck twice a day to prevent melasma.
- Taking an oral anti oxidant supplement such as Ovelle or Heliocare daily is clinically proven to raise one's level of resistance to the sun and also helps to reduce the melanin content in the skin down the line.
- As melasma is a dynamic condition and needs to be managed daily and indefinitely, one day of unintentional sun burn can set you back.
What are the different types of Melasma? (This describes how deep the pigment is in the skin and how to treat it)
- Epidermal melasma is the most common form and is easily treated with a combination of superficial chemical peels, Laser procedures.
- If the melanin has leached into the dermis, this is known as dermal melasma. The deeper the pigment is and the more difficult it is to treat. Dermal melasma is not treated with superficial peels and is best treated with mid dermal peels such as a Mela M or the Max G Laser, which can penetrate into the dermis to reach the pigment.
- Mixed Epidermal-Dermal is a combination of the above and needs superficial and mid dermal chemical peels such as Lamelle Mela M.
In office treatments for Melasma:
- We emphasise that home lightening products such as Neostrata or Luminesce must be used routinely for 2 weeks on the entire before any exfoliation treatment such as peels.
- Neostrata and Luminesce also contain Retinol which increases the cell turnover so that the deposition of melanin is impeded and the recovery from any exfoliation procedure is enhanced.
- Epidermal Melasma is the most common form of Melasma and can be treated with pulsed light treatments such as Limelight , Photo Genesis and a combination of epidermal peels such as Lamelle Beta Peels and TCA or Mela M.
If the above recommendations and treatments are followed, after a period of time, the pigmentation does fade but one day of unintentional sun burn can set you back.
The following is a list of skin care ingredients to USE if you have Melasma:
Arbutin, bearberry, cucumber extract, hydroquinone, kojic acid, licorice extract, magnesium ascorbyl phosphate, mulberry extract, niacinamide, retinol, resorcinol, beta hydroxyl acid, vitamin c.
The following is a list of skin care ingredients to AVOID due to worsening melasma pigmentation and dark spots:
Oestradiol, oestrogen, genistein, black cohosh, chasteberry, hops, red clever, soy, wild yams.
Virtually any patient can be a candidate for a lightening of their pigmentation depending on the area. As each patient's case is different; we will tailor a treatment program specifically for you and your circumstances. An appropriate combination treatment together with long term maintenance program is recommended dependant on expectations, budget, time and medical conditions.