Melasma is a common problem in darker skin types (Fitzpatrick phototypes IV-VI) such as Asian and African skins. It is a chronic and rather difficult to treat skin disorder. Women are more commonly affected than men. Melasma
Melasma is a common problem in darker skin types (Fitzpatrick phototypes IV-VI) such as Asian and African skins. It is a chronic and rather difficult to treat skin disorder. Women are more commonly affected than men. Melasma occurs when pigment producing cells (melanocytes) produce too much pigment called melanin. Although the exact cause of melasma is not fully established, it has clear association with increased exposure to sunlight (especially ultraviolet rays) and female hormonal activity. This is the reason why there is increased incidence of melasma during pregnancy and in those women taking oestrogen containing drugs like oral contraceptive pills and hormone replacement therapy. In one third of patients there is genetic predisposition.
Melasma can present as large brown or brown-gray/blue patches or small freckle like spots on different parts of face such as cheeks, nose, forehead and chin. Depending on which parts of the face are affected, melasma can be: centro-facial (cheeks, upper lip, forehead, chin and nose), malar (cheeks and nose) or mandibular (jawline). Melasma can be superficial (epidermal), deep (dermal) or mixed types.
Melasma and other types of pigmentation can be treated using similar treatment methods. Many of the topical treatments used in the treatment of melasma basically act by inhibiting tyrosinase which is an enzyme produced by melanocytes and is crucial component in the production of melanin pigment in the skin. When the activity of tyrosinase is restricted, the skin makes less melanin. Examples of tyrosinase inhibitors include hydroquinone, kojic acid and arbutin. Other topical agents used in the treatment include antioxidants and retinoids.
One important aspect of treatment of melasma to keep in mind is that the results take time to be noticeable and are rarely 100% successful. Even in those lucky patients who get initial good results, pigmentation can reappear after some time of treatment especially if patients are not particular with strict sun protection or under the influence of female hormones as if a woman gets pregnant.
-Complete sun protection throughout the year with the use of broad-spectrum sun block creams is an integral part of treatment of melasma.
-discontinue hormones containing contraceptive pills
– use a gentle skin cleanser and mild moisturiser on a regular basis
-In order to disguise the pigmented areas, cosmetic camouflage can be used
Hydroquinone: This is the most commonly used topical drug for the treatment of melasma and other pigmentation disorders. Although the mis