Melasma 101: Everything you need to know about the common skin pigmentation condition
Sun moustache. Pregnancy mask. Paint splatter. Melasma is a common skin pigmentation disorder that goes by different names - and appearances. Is it harmful to our skin? Is it treatable? How do we even know if we have melasma?
Ahead, we have all the facts you need on melasma - including insights from Dr Jonathan Lee of The Aesthetic Studio on effective and sustainable solutions you can consider to tackle this common skin condition.
So, what exactly is melasma?
Melasma is a common type of hyperpigmentation that results in brown to grey-brown patches, and typically appears on the face, especially on the cheeks, forehead, chin, and the bridge of the nose.
That said, Dr Lee stresses the importance of making the distinction, stating that people should understand that melasma is a pigmentation disorder but not all facial pigmentation is melasma.
“Diagnosing melasma correctly is important, because it requires different treatments from other types of pigmentation and may not even respond to simpler treatments,” Dr Lee lets on.
It’s also important to acknowledge that melasma is prone to frequent recurrences, he adds.
The cause of melasma remains unknown but is believed to be due to an increase in the production of cells that release the pigment melanin, leading to the darkening of the skin.
What are some of the common triggers of melasma?
There are multiple factors that are thought to trigger melasma including some cosmetics, oral hormone-based contraceptive pills, hormone therapy, drugs that cause sun sensitivity, certain anti-seizure medications as well as sun exposure.
Melasma can often be traced through family history too, so if your mother or grandmother has the tendency of getting melasma, the chances of you seeing pigmented patches on your skin are high.
In addition, melasma is highly common during pregnancy and after childbirth. Pregnancy-related melasma is referred to as chloasma or the "pregnancy mask".
“We also notice increasing incidences of melasma-type pigmentary complaints as women approach peri-menopause,” Dr Lee adds.
Are women more prone to getting melasma than men?
Indeed, most melasma occurs in women so we know there is a hormonal trigger or influence, says Dr Lee. Men make up about 10% of cases.
How do you know if you have melasma?
Melasma is so common and has very characteristic appearances (it’s a smokey, cloudy, and dull pigmentation that’s often patchy with clear spots), but the diagnosis of melasma is best made by a qualified physician who is able to tell in most cases by just looking at the skin.
It’s worth noting that the condition is universal and seen in all cultures and ethnicities; however, it is far more common in people with darker skin tones including those of Asian, Hispanic, Latin, Indian, Middle Eastern, Mediterranean, and North African descent.
Individuals with these backgrounds have higher levels of melanin in their skin and a tendency to tan. Those with fair skin may experience a lighter shade of melasma, which is not always recognised.
When developing a treatment plan, Dr Lee posits that “ethnicity is an important factor to consider” because “the normal background colour of the skin may make certain treatments such as lasers, IPL, and other light-based treatments less suitable.”
“It is important to have multiple treatment options available and tailor treatments individually, especially when treating different ethnicities, to minimise risks and optimise results.”
Are topical skincare products effective enough to tackle melasma?
Topical anti-ageing products such as retinols, anti-oxidants, and exfoliating hydroxy acids that you can get over the counter are useful for improving skin health and delaying the signs of skin ageing in general.
Dr Lee opines that these formulas benefit everyone including those dealing with melasma but he cautions that they should be introduced into your routine one by one in lower doses. This is to ensure your skin has time to “gradually acclimate itself, and avoid irritation.”
On the other hand, you can also consider prescribed topical products which include drugs such as hydroquinone (a chemical that blocks pigment production in the skin) and light steroids (which reduce inflammation). These can only be obtained with a doctor's prescription so they are not available over the counter.
“I generally recommend that patients be observed and followed up when using these products, to judge effectiveness and adjust dosing accordingly, and to manage any unwanted effects. These products are typically used for short periods of several months, followed by treatment breaks or intervals,” remarks Dr Lee.
What are the in-clinic treatments that can potentially treat this type of hyperpigmentation?
In-clinic treatments are very useful and helpful for the treatment of melasma, but topical treatments should be the first line of defence even though they do take a while to work. It’s also vital that we have to be patient when treating a pigmentary condition such as melasma as it involves a lot of trial and error.
“Ultimately, patients want clearer, healthier, younger-looking skin. Having a good pre-treatment assessment ensures they get the correct treatment, while minimising the risks and disappointments,” shares Dr Lee.
Before looking at in-clinic treatments, you can first optimise your home-based anti-ageing skincare for the long term. “Both doctor and therapists will review your home care, and ensure that you have products in each category such as retinols, anti-oxidants, acids, hydration, and sun protection,” Dr Lee explains.
From there, the professionals will recommend items best suited to your skin type while guiding you through the proper order of use to ensure correct application and tolerance before increasing concentrations over time in a guided fashion.
“Doctors may then introduce, prescribe, and supervise the use of prescription products that include specialised hydroquinone (or its alternatives) and steroid formulations.”
That said, there may be some of us whose skin might not tolerate these topical products due to skin sensitivities. In this case, in-clinic procedures can be considered “very useful adjuncts to treatment” especially when “some of the other pigment production processes cannot be addressed by creams or tablets alone.”
These protocols include chemical peels, laser or light-based treatments (with or without infusion of products), and more recently, radiofrequency microneedling.
According to Dr Lee, light-based treatments such as IPL and lasers have long been used to treat existing pigment in the skin and down-regulate new pigment formation to potentially achieve faster results.
“That said, some caution is required when treating melasma with these modalities as overzealous application of energies can sometimes paradoxically irritate the skin and exacerbate the condition,” he expounds.
While light- and laser-based treatments target pigment directly and the cells that produce them, radiofrequency microneedling treatments aim to normalise the overactive and inflamed blood vessel network in melasma-ridden skin, restoring healthy skin characteristics.
“These treatments also potentially create temporary micro-channels for the administration of antioxidant and anti-pigment topical products.”
If you’re considering oral prescription treatments such as ingestible tranexamic acid tablets, do exercise caution.
“It may sound simple; however, these are taken into the body and may affect other body systems, therefore it should only be considered for the short term with supervision,” Dr Lee says.
Is there anything that can be done to prevent melasma?
The unfortunate reality of melasma is that there are currently no ways to prevent melasma. However, it is possible to manage the condition with daily long-term care before, during, and after clinic treatments.
Here are our recommendations:
Meticulously use a topical broad-spectrum SPF 50+ sunblock: A teaspoon (approximately 5ml) of sunblock should be applied twice a day to the face, neck, and décolleté (chest area).
Products you can try: Heliocare 360 Gel Oil-Free Sunscreen Dry Touch SPF50 High (oil-free) or Skinceuticals Sheer Physical or Physical Fusion (a physical sunblock for sensitive skin)
Include topical antioxidants with vitamins C and E, ferulic acid, and phloretin: These help to protect against UV and infra-red spectrum light.
Products you can try: Skinceuticals Phloretin C or Skinceuticals CE Ferulic serum
Consider using a topical pigment-correcting product such as Cysteamine Cream® - it is a novel pigment corrector for hyperpigmentation concerns. Naturally present in human cells, cysteamine reduces melanin in the skin epidermis, effectively removes brown spots, reduces pigmented marks, and produces a uniform and light skin complexion.
Incorporate oral antioxidants in your daily routine: These supplements, when consumed alongside topical sunscreens, can help further safeguard your skin against damaging UV rays.
Products you can try: Heliocare (contains Polypodium Leucotomos extract from the central American fern) or Crystal Tomato® (contains carotenoids)
Avoid hot baths, steam or dry saunas, and hot yoga which may cause excessive inflammation of the skin, so it’s best to keep these to the bare minimum if you have melasma.
Wear a broad-brimmed hat when outdoors - you get to protect your skin while looking extremely fashionable.
Hormone-balancing treatments may be required for patients experiencing hormonal fluctuations around menopause, and for patients taking hormone treatments (e.g. oral contraceptives), and this should be discussed with our doctors.
It may take several months for improvement to occur, so it is important to follow up with our skincare staff and stick to the recommended homecare routine in order to maximise the benefit from our in-clinic melasma treatment.
In addition, our experienced nurses and doctors can recommend quality cosmetics that will not trigger melasma as well.
If you are dealing with melasma and are currently shopping for an effective long-term program to manage this skin disorder, book a consultation with Dr Lee today.