It commonly presents as brown black patches on skin mostly on the face and is common in dark skinned patients. Here we try to dispel few myths about melisma, its causes and treatment modalities.
Q) What is the Cause of Melasma?
a) Sunlight or UV Radiation - UV radiation can trigger or exacerbate melasma by increasing stem cell factor which increase proliferation of melanocytes.
b) Family History - It is an important risk factor for developing melasma with as high as 55 -64% of patients having a positive family history.
c) Horomonal Influence - They play a significant role in the pathogenesis of melasma as seen by the increased prevalence with pregnancy, oral contraceptive use and other hormonal therapies
Q) What are the Types of Melasma?
There are Three Variants of Melasma
Epidermal - There is increased melanin or pigment in all the layers of epidermis. Melanocytes are enlarged and have more melanosomes.
Dermal - There are melanophages in superficial and deep dermis.
Mixed - Combined features of epidermal and dermal melasma.
Q) What are the treatment modalities for melasma?
A broad spectrum sunscreen protecting against UVA and UVB and even Infrared radiation is the pillar of treatment of melasma. It is the most essential aspect of treatment.
- Hydroquinone (HQ) - This compound works by inhibiting tyrosinase which prevents the conversion of DOPA to melanin.It also directly leads to melanocyte destruction and melanosome degradation. Prolonged use can cause irritant dermatitis in some individuals and chronic use can lead to exogenous ochronosis .
- Retinoids - Topical retinoids improve melasma by promoting keratinocyte turnover and can be used in patients with photoageing for improvement of rhytides.
- Natural Topical Therapies - Niacinamide inhibits melanosome transfer to keratinocytes hence decreasing pigmentation. Both ascorbic acid and kojic acid can inhibit tyrosinase activity and have been shown in small studies to lead to decreased pigmentation. Another natural compound, azelaic acid is effective in improving pigmentation by inhibiting tyrosinase activity. It is derived from the yeast, Pityrosporum ovale and also has anti-inflammatory effects.
- Soy , Arbutin or licorice has also been found to be efficacious in removing pigment.
- Chemical Peels Glycolic acid (35 -50%), TCA 15% , Mandelic acid are a few agents which are a useful adjuvant in improving the results. Yellow peel is very helpful in improving the results.
- Microneedling - In conjunction with depigmenting agents is very helpful in improving the results of the treatment.
- Lasers and Lights - Non-ablative lasers are preferred for the treatment of melasma over ablative as they have a lesser tendency to cause less post-inflammatory pigment alteration (PIPA). They help in permanently reducing the size of melanocytes and melanosomes. We at DSHS utilize SPECTRA GOLD, one of the pioneers in Q switched Laser and the only FDA approved laser for Melasma.