Melasma Treatment & Management
Written by Dr Branden Seow
What is melasma?
Melasma is a common skin condition that most Asians face. Melasma presents itself as dark or light brown/lack patches on the skin. They can either appear as flat patches or freckle-like spots. Ares of the face that can have melasma include the cheeks, forehead, chin and sometimes nose. Melasma is more likely to occur in women than in men. Genetics can play a strong part in developing melasma for some individuals. There are also other risk factors for developing melasma that include being pregnant, exposure to sun, as well as taking oral contraceptives.
In the skin, at the layer of the epidermis are cells called melanocytes that store and produce melanin. Due to exposure from ultraviolet radiation (UV) or by hormonal stimulation, the melanocytes produce more melanin, giving rise to dark pigments on the skin. While melasma is not harmful to the body, it is understandable that many people want to address it.
There are a few ways to help reduce the risks of melasma developing or from getting worse or improving the colour and appearance of the melasma patches.
Ways to address melasma
The first way is by lifestyle changes. Active sunblock or sun avoidance measures should be done. It is good to apply a broad-spectrum sunscreen daily. Sunscreen with physical blockers such as zine or titanium or iron oxide are recommended. Sunscreen with iron oxide has been shown to protect against visible light as well. Exercising at night or indoor poses lower risk of exposure to UV than exercising in the morning. When outdoors, it is good to wear a hat or cap to reduce sun exposure to the face.
Topical medications
The second way is by using topical medications. There are currently various products in the market that can help to lighten melasma. The key is to look at the active ingredient of the product to determine how it can lighten melasma. There are various mechanisms that products can help to lighten pigments and melasma.
The best-studied and most widely used topical depigmenting agent is hydroquinone, a compound that inhibits tyrosinase, an enzyme there is responsible to produce melanin. There are various studies that had shown the depigmenting effect of hydroquinone is enhanced when used with a retinoid and a corticosteroid. Retinoids promote pigment loss by increasing epidermal turnover, as well as inhibits tyrosinase. The corticosteroid component helps to limit the potential irritative properties that hydroquinone and retinoid may bring.
There are also ingredients that can help with melasma, when combined with other compounds. Azelaic acid, tranexamic acid, and kojic acid are some common compounds that are often used as part of a combination of agents used for lightening. Azelaic acid has anti-tyrosinase properties. Tranexamic acid can lead to reduced tyrosinase activity. Kojic acid acts as an antioxidant and also can help with epidermal penetration of other medications through increased cell turnover.
Antioxidants derived from nature and natural extracts are also used for skin lightening due to their anti-inflammatory and skin brightening and properties. Arbutin, aloe vera, silymarin, arbutin, resveratrol, niacinamide, ascorbic acid, and extracts of soy, coffeeberry, orchids, green tea, grape seed, and licorice are also some common ingredients that can be found in cosmeceutical products that help with pigment lightening. In addition, Polypodium leucotomos (a fern extract) is an oral antioxidant that has also demonstrated photoprotective effects.
Lasers for Melasma
The third way is by using lasers to help lighten the pigments. At The Clifford Clinic, there are several lasers that can be used to help lighten pigment.
Pico laser is popular nowadays to treat pigments and melasma. Pico-Laser works by shooting high-intensity laser pulses for a very short time, a picosecond, which is about one trillionth of a second. By delivering short pulses of laser energy that targets the pigment or melasma, Pico-laser breaks the pigment down so your body can naturally clear it by triggering the immune response of the body. Several sessions are usually required to see improvement.
Before the advent of Pico-laser, the Q-switch laser has been commonly employed for pigmentation lightening and clearance. As with all technology products, they evolve and improve over time. Pico-laser technology was evolved from Q-switch. This however does not mean that Q-switch has lost its value. Pico-laser is able to break pigments into smaller fragments compared to Q-switch. As such, both Q-switch and Pico-laser can be used synergistically in one setting to promote faster pigment clearance.
In addition, there is one more laser The Clifford Clinic houses that can help with pigmentation clearance. It is called the FRAXEL laser. Several studies had shown the benefit of the 1927 nm wavelength of the FRAXEL laser for treatment of melasma and pigments.
The main difference between FRAXEL and Q-switch/Pico-laser in treating pigments is that there will be downtime post-laser for FRAXEL. The downtime is due to the redness that will appear after FRAXEL laser treatment.
In conclusion, there are various ways that exist that can help lighten melasma pigments. It is best to speak with one of our doctors at The Clifford Clinic to better understand your needs and to tailor the specific treatment that is right for you!