Melasma

 

Living with Melasma can be troublesome for patients. As with many skin conditions, Melasma is not curable, and it can also leave you with discoloured patches on the face if left untreated. But don’t despair. Fotona lasers offer patients a workable solution with excellent results.

Of the many skin conditions that are treated today is Melasma, which causes discolouration [or dark spots] on the skin. A form of hyperpigmentation, Melasma is more commonly seen in women with darker skin tones.

However, Melasma remains in a league of its own.

Though the jury is still out on what causes the skin condition, however, there is a strong connection to a variety of hormonal influences especially during pregnancy, when taking oral contraceptives or when you’re undergoing treatment for Hypothyroidism and excess cortisol [a steroid hormone caused by trauma or stress].

Some patients with estrogen and progesterone imbalances may also be at risk along with those who expose specific areas their skin to ultraviolet rays [especially around the neck and arms], which stimulates the cells that control pigment (melanocytes).

 

How does Melasma occur?

Melasma occurs when there is overstimulation to the melanin-producing cell [melanocyte] in the epidermis or dermis layers of the skin. The melanosomes found inside the cell produces excess pigment and then deposit the pigment into adjacent skin cells [keratinocytes] resulting in dark brown patches of skin most commonly found on the face.

 

So what are the telltale symptoms of melasma?

Many skin conditions fall into the category of hyperpigmentation, including skin rashes and freckles, which can form into full-blown brown spots. But what distinguishes melasma from traditional hyperpigmentation is its symmetrical-shape appearance and location.

The patches of discolouration which are darker than the natural skin colour typically occurs on both sides of the face.  This includes the cheeks, forehead, chin, upper lip and around the bridge of the nose.

Nevertheless, Melasma can also affect other areas of your body, including your forearms and neck if the skin has been heavily exposed to UV rays.

 

Is Melasma curable or treatable?

Melasma is not curable, but it is treatable. However, an imbalance with your hormones will likely have a troublesome effect on the success of the treatment and influence future outbreaks.

For this reason, it is essential to first have your hormone levels checked by your GP or endocrinologist along with the condition of your skin before undergoing any treatment.

The other issue is Melasma’s location. The deeper the pigment-making cells are in the skin, the more difficult the condition is to treat. And as with any untreated skin condition that continues to trigger a surplus of pigment, Melasma has the potential to stimulate more melanocytes deep in the dermal layer [second layer of skin].

                                                                                                       

Can I use bleaching creams to lighten the spots?

Yes.  Topical bleaching creams with hydroquinone [HQ] and steroids can be prescribed to strip away the top layer of the skin and help lighten any brown patches. However, the ingredients only address the epidermis layer and cannot be used for any extended time.

Of the side-effects with prolonged use includes skin sensitivity, inflammation, photosensitivity and irritation, all of which will further impair your natural barrier function. Even worse, the Melasma will return with unwavering persistence, especially if you’re on an oral contraceptive or undergoing other hormonal therapies including thyroxin and HRT.

 

What should I avoid to prevent an outbreak?

Strict avoidance of sun is essential As UV rays can trigger or exasperate the condition, you must avoid direct sunlight. A minimum of SPF-30 should be applied daily along with mineral makeup. Also, avoid steaming hot showers. Excessive heat will further accelerate the production of pigment, which is why more patients are prone to outbreaks during the summer months than winter.

If your skin is already photo-sensitive, and you suffer from inflammation, the health of your natural skin barrier will also affect the condition. Any attempts to reduce any pigmentation through excess exfoliation will only worsen the condition along with a skin-care regime that includes a combination of intense active ingredients such as retinol [Vitamin A] and pure Vitamin C.

In the same way, lightening products or bleaches, as well as intense exfoliation, may exacerbate the pigment production within the melanocyte, leaving you susceptible to another outbreak.

So let’s start at the beginning and allow us to introduce a series of gradual and corrective steps starting with:

  • Assessing the health of your skin. This will allow us to customise a gentle but effective skin recovery regime which will help restore the compromised skin barrier.
  • Determining where the increased pigment is in the skin’s layers [whether the Melasma is found in the epidermal or dermal layers]. This is especially important as most dermal Melasma is usually unresponsive unless the patient undergoes a series of Fraxel laser treatments.

How can I effectively treat Melasma?

If required, we will prescribe a topical agent that includes hydroquinone (HQ), a chemical that reduces tyrosinase, an enzyme that influences the production of melanin and other pigments. To effectively target Melasma which is rooted deep within the dermis, we will also begin a series of non-invasive, long-pulse and high-performance Q-Switched Ns: YAG laser treatments.

How is the treatment applied?

As melanosomes have an estimated thermal relaxation time of 10-100 nanoseconds, 1064 nm wavelengths of laser energy will be emitted in short pulses to effectively target melanosomes in the nanosecond range. In turn, the targeted heating and nanosecond pulses will penetrate the deeper -lying and tiny particles of pigments in the dermis through the delivery of photoacoustic energy and effectively breakdown the pigments without damaging the surrounding tissue.

What are the other benefits of the treatment?

The short laser pulses not only expels the targeted pigment but also stimulates the production of collagen and elastin, leaving you with a more rejuvenated appearance within a week of the treatment.

What preparation steps are necessary for laser treatment?

You will be instructed to avoid direct sun exposure up to four weeks before the treatment. If your skin barrier has been compromised by any number of internal and external influences, we will also help restore the required balance and hydration and recommend that you treat any hormonal imbalances.

A full consultation and assessment will be conducted by Dr Chang, which will determine the category and parameters of Melasma.

Will there be any downtime?

A typical treatment takes less than 50 minutes including preparation time. Patients may experience low levels of discomfort during the procedure but typically experience mild swelling and redness immediately after the treatment for up to several hours.

Some patients may also see a temporary darkening of the pigment, which soon fades as the cellular process begins to take effect.

Can the condition reoccur?

Yes, so it’s important to avoid the key triggers by limiting sun exposure, wearing a hat where possible and applying SP30 sunscreen.

It’s also important to you remain vigilant with your skincare regime to reduce the risk of the skin condition reoccurring.

For optimal results in treating Melasma, it is recommended that patients undergo a series of Fotona laser treatments spaced between 2 to 4 weeks apart. The full rejuvenation process will take approximately two months. 

Our senior dermal therapist will also customise a post-recovery skincare regime which may include KCeutic Post Recovery Cream, Cosmedix Rescue + and Medik8 products.