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31 Aug Melasma : What is this and what treatment is required
Melasma is an acquired hyperpigmentation that mainly affects the face. It is more common in women of reproductive age, darker skin types such as Hispanics, Latinos, Asians and Africans. It can be caused by excessive melanin (pigment) deposition in the epidermis (more superficial zone of the skin) or dermis (deeper).
Female sex hormones are thought to play a role in melasma.
Pregnancy and the use of oral contraceptive pills are triggering factors1.
No single therapy works in all patients.
UV and visible light can induce melanin (pigment) formation and cause or worsen melasma. Sunscreen with an SPF of >30 (UVB) and UVA rating of >3 stars is recommended on a daily basis (lifetime), in addition to sun avoidance. Use of sunscreen prevents melasma and enhances the efficacy of other treatments.
One of the most effective topical (cream) treatment is a combination of hydroquinone 4% (bleaching agent), 0.05% tretinoin (vitamin A) and 0.01% fluocinolone acetonide (cortisone) nightly for a minimum of 8 weeks.
Side effects include redness, desquamation (peeling), burning, dryness and itching. The frequency of application can be decreased if this occurs.
Hydroquinone can cause a bluish-gray discoloration known as ochronosis especially in South African Blacks.
These can be added to the combination therapy cream regimen however they do not improve the results very much. The only recommended chemical peel is the glycolic acid, however it can cause hyperpigmentation (dark spots on the skin similar to melasma).
Lasers such as the Q-switched ruby laser and the erbium-YAG laser worsen melasma.
CO2 laser do not improve melasma.
Fractional resurfacing laser have shown benefit in improving melasma.
Intense Pulse Light (IPL) has shown modest benefit in improving melasma.
Laser should only be used if other options have failed2.
1. Ai-Young Lee, An Updated Review of Melasma Pathogenesis. Dermatologica Sinica. DEC 2014;32(4):233-239
2. Jutley GS, Rajaratnam R, Halpern J, Salim A andEmmett C. Systematic review of randomized controlled trials on Interventions for Melasma: An abridged Cochrane review. Journal of the American Academy of Dermatology;70(2):369 – 373