Melasma is more common in women than in men, with an onset typically between the ages of 20 and 40 years. The cause of melasma is complex; it has been proposed to be a photoageing disorder in genetically predisposed individuals.
Factors implicated in the development of melasma include:. Melasma presents as bilateral, asymptomatic , light-to-dark brown macules or patches with irregular borders. Melasma can be separated into epidermal, dermal, and mixed types, depending on the level of increased melanin in the skin.
Melasma Melasma. Melasma can have a severe impact on quality of life due to its visibility. Melasma is usually a clinical diagnosis based on the clinical appearance, and examination with a Wood lamp and dermatoscope. Occasionally a skin biopsy may be taken. Histology varies with the type of melasma, but typically the following features are seen:.
Tranexamic acid blocks conversion of plasminogen to plasmin, with downstream effects inhibiting synthesis of prostaglandin and other factors involved in melasma.
Chemical peels and lasers can be used with caution, but carry a risk of worsening melasma or causing post-inflammatory hyperpigmentation. Patients should be pretreated with a tyrosinase - inhibitor , such as hydroquinone. Superficial epidermal pigment can be peeled off using alpha-hydroxy acids AHA , such as glycolic acid, or beta-hydroxy acids BHA , such as salicylic acid.
Microneedling, intense pulsed light IPL , and lasers including Q-switched Nd:YAG , ablative and non-ablative fractionated and picosecond lasers carry a high risk for relapse and the disease becoming more resistant to treatment, so require expert use.
Melasma can be frustrating to treat, both for the patient and the medical practitioner. It is slow to respond to treatment, especially if it has been present for a long time. Even in those who get a good result from treatment, pigmentation may reappear on exposure to summer sun. It is due to excessive pigment melanin collecting in the skin. The dark patches usually have distinct edges and are symmetrical similar on both sides of the face.
Melasma is very common and occurs in up to six million American women. Although people with melasma may be concerned about its appearance, it is a harmless condition that causes no other health problems. Epidermal melasma means the pigment melanin is in the more superficial layers of the skin called the epidermis.
Dermal melasma means that the pigment is in the deeper layers of the skin. This distinction is important because epidermal melasma responds more quickly to treatment. Although melasma can occur in men, it is most common in women, especially in women of Hispanic or Asian ancestry. If your relatives had melasma, you are also at greater risk of developing melasma. Women are also at greater risk of developing melasma if they are pregnant, take birth control pills, or take hormone replacement therapy.
Sunlight is essential to the development of melasma. People at risk of developing melasma will notice the patches becoming darker following exposure to sunlight. Treatment results vary greatly among individuals. Studies suggest that estrogen receptors on melanocytes can stimulate the cell to produce more melanin. A useful tool in identifying the intensity of the melasma in a patient is the Melasma Area and Severity Index score.
For some patients, cessation of hormone-altering medications and the normal rebalancing of hormones after pregnancy can cause melasma to fade on its own. This is known as transient melasma. For others, unfortunately, their melasma is known as persistent and can stay pronounced indefinitely. There have been many studies suggesting that the use of gentle, topical home care products and professionally applied treatments is the best way to treat melasma.
Placing patients on a daily care regimen with products that include a variety of the following ingredients will help suppress the formation of excess melanin through multiple mechanisms of action, delivering faster, more beneficial treatment outcomes:. This ingredient inhibits copper from binding with tyrosinase and induces melanocyte-specific cytotoxicity.
They are synthetically produced and suppress the activity of tyrosinase, decrease the quantity of melanosomes and inhibit melanosome transfer into keratinocytes. Not only are retinoids melanogenesis inhibitors, they also boost cell turnover, which helps accelerate the lifting of hyperpigmented cells. Retinoic acid is an effective topical ingredient, but can be too stimulating for some. Retinol is an effective alternative that is much less irritating and converts into retinoic acid within the skin.
A stabilized pure retinol at 0. It provides anti-proliferative and cytotoxic effects on melanocytes and inhibits tyrosinase. It prevents the synthesis of the melanocyte stimulating hormone and suppresses the formation of tyrosinase, and melanin and melanosome transfer.
The use of antioxidants, and calming and soothing agents, such as epigallocatechin gallate and resveratrol, can help in the treatment of melasma as they prevent inflammation in the skin and therefore reduce the incidence of excess melanin formation. A broad-spectrum sunscreen with a minimum SPF of 30 is needed for patients experiencing melasma. The reactivity of skin prone to hyperpigmentation and melasma is exacerbated by UV-induced inflammation.
Therefore, choosing an SPF with added melanogenesis inhibitors and antioxidants can provide additional treatment and pigment suppression along with necessary UV protection. All sunscreens must be applied 30 minutes before sun exposure and reapplied every 2 hours, or after swimming or perspiring, for maximum protection. Along with a gentle daily care regimen, adding professional treatments can provide a more beneficial outcome. Performing a series of gentle, superficial blended chemical peels containing a combination of lower percentage acids that also contain melanogenesis-fighting ingredients is an excellent way to accelerate the treatment of melasma.
Low percentage blends of trichloroacetic acid and lactic acid help to gently remove dead surface cells without causing unwanted inflammation in the skin. This creates the perfect canvas for corrective products to penetrate deeper in the skin to treat the unwanted pigmentation.
Cream-based retinoid treatments are effective when addressing melasma as well, since the inflammatory risk is so low. Retinoid formulations containing antioxidants such as glutathione, bilberry extract and grape seed extract; and melanogenesis inhibitors including lactic and kojic acids, rumex occidentalis and arbutin, are excellent options. Overtreatment of melasma is quite easy and will cause a worsening of the condition.
Anything that causes heat or friction in the skin can stimulate an increased deposit of excess melanin at the site of trauma. This has been demonstrated in many studies assessing the use of intense pulsed light, laser, microdermabrasion and high percentage chemical peels to treat melasma. Another mechanical treatment that has shown added benefits in melasma treatment is microneedling.
Microneedling has grown exponentially in recent years. This treatment provides an effective physical method of enhancing transdermal delivery of topical ingredients for various skin conditions without causing heat on the skin. Microneedling can be performed with a roller, or pen, which is covered with multiple tiny needles.
The needles range in length and can penetrate into the skin up to 2 mm. This not only stimulates collagen production, but also facilitates the penetration of corrective products through the epidermis. It creates minor trauma to the skin, creating less risk of complications, and is generally more cost-effective than comparable laser therapy treatments. Using a shorter needle gauge will limit the depth of penetration and decrease the risk of further pigment formation.
Although frustrating for both patients and the skin health professionals working to treat it, melasma can be successfully treated. It is important to note that patients prone to hyperpigmentation and melasma will always be susceptible to recurrence. It is wise to have these patients remain on a continuous regimen containing melanogenesis-suppressing ingredients.
A combination of year-round daily care with several pigment-inhibiting ingredients, consistent broad-spectrum sun protection and regular, professionally applied, gentle chemical peels can provide immense improvement of this stubborn condition. Linder, board-certified dermatologist and fellowship-trained Mohs skin cancer surgeon, is a volunteer clinical instructor in the Department of Dermatology at the University of California, San Francisco.
Linder is in private practice in Scottsdale, AZ. Disclosures: Dr. Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. Bhor U, Pande S. Scoring systems in dermatology. Indian J Dermatol Venereol Leprol. Linder J. Treatment strategies for challenging melasma cases. Sign in. The Dermatologist. Dermatology Week. Current Issue. Editorial Information. Author Guidelines.
0コメント