What is Melasma?
Melasma refers to the brownish patches found on the skin in photoexposed areas. These spots, which appear especially on the face, are caused by excessive accumulation of melanin. These completely harmless pigment changes usually decrease on their own after hormones stabilize, after stopping birth control pills, after pregnancy and breastfeeding, and so on. However, not always, and then you need to help the skin even out and reduce melasma on the upper lip.
Certain internal and external factors, such as sun exposure, genetics, hormonal changes, inflammation, and age can affect melanin production. Excessive melanin production leads to hyperpigmentation, where dark spots and uneven complexion appear. Insufficient production of melanin-hypopigmentation has the opposite effect, and spots without pigments appear on the affected area
The lesions, often irregular in shape, are located:
on the forehead
on the cheeks
on the upper lip
on the chin or the lateral and lower portions of the face
more rarely in the neck and upper limbs
What causes melasma?
Melasma is caused by the excessive production of melanin pigment. Although this condition occurs in response to hormonal changes such as pregnancy, birth control pills, or hormone replacement therapy (HRT), other factors such as exposure to UV radiation, family predispositions, age, and some epilepsy medications can also have an effect.
Melanocytes (melanin-producing cells located in the basal layer of the epidermis) are responsible for increased epidermal pigmentation in melasma. During pregnancy, endogenous hormones stimulate melanocytes, causing them to produce more melanin pigments.
Women who take birth control pills or take hormone replacement therapy (HRT) can get melasma because their bodies go through hormonal changes similar to those that occur during pregnancy.
Exposure to UV radiation is also one of the main causes or aggravating factors in the development of melasma, so it is recommended that people who are prone to the condition or have a family history of melasma, avoid the sun and use a high-factor, broad-spectrum sunscreen to protect themselves. avoided stimulating pigment production.
Types of Melasma
Epidermal Melasma
characterized by hyperpigmentation generally light brown. There is greater color contrast with Wood’s light, compared to visible light. From a dermatoscopic point of view, however, a dark coffee-colored pigmentary network is highlighted in the stratum corneum, and an irregular, light coffee-colored pigmentary network, with the follicle intact in the basal epidermal layer.
Dermal Melasma
its peculiarity is that, upon dermatoscopic inspection, a light blue-grey pigmentary network is highlighted. This network appears due to the presence of melanin in macrophages.
Mixed Melasma
a fine dark brown color presents irregularly increased hyperpigmentation contrast in Wood’s light.
Melasma in skin phototype V-VI
characterized by pigmentary lesions visible even in daylight. However, they are not made more obvious in Wood’s light, melanin is in the dermis.
Melasma with telangiectasia
it is a melanin hyperpigmentation with a vascular component. There is a correlation between Wood’s light examination, dermoscopy, and the depth of the melanin pigment.
Mixed Melasma
(a combination of epidermal and dermal) manifests itself as a brown-gray pigment. Because of the depth of the melanin pigments in dermal melasma and mixed-type melasma, these two forms can be more difficult to treat.
Diagnosis
The diagnosis passes through a specialist visit, which initially involves an anamnesis of the patient, to evaluate the clinical picture and an objective examination. The specialist will make the diagnosis by examining the skin.
To analyze the hyperpigmentation of the epidermis and thus confirm the diagnosis, the doctor will be able to carry out a specific examination with the Wood’s lamp. The diagnosis will be necessary to avoid confusing melasma with others.
Pigmentation-inducing pathologies such as:
- Infections, syphilis, herpes simplex, impetigo
- Hyperthyroidism
- Gaucher disease
- Occupational melanosis ( anthracene and phenanthrene phototoxicity )
- Exogenous ochronosis with perifollicular pigmentation
- Fixed drug rash, lichenoid drug eruption
- Eczema, neurodermatitis
- Cosmetic pigmented dermatitis
- Photodermatitis, topical use of corticosteroids
- Post-inflammatory hyperpigmentation
- Radiodermatitis
- Macular amyloidosis
- Cutaneous lymphoma
How long does melasma last?
This disorder can either last a few years or become permanent, even being decidedly evident. It is also possible that the spots will fade spontaneously once you stop taking the contraceptive pill or after giving birth.
The most difficult, or the biggest challenge, is the destruction of melanosomes, more precisely the cells that produce pigment. Destruction of melanosomes can lead to inflammation that can worsen melasma. To improve the condition, good cooperation between the doctor and the patient is necessary.
Risks
As regards complications and any related risks, melasma does not entail consequences from a pathological point of view, representing an aesthetic disorder.
In melasma, both inflammatory mediators and growth factors such as VEGF ( vascular endothelial growth factor ) are overexpressed. It is found that these elements induce an inflammatory and oxidative microenvironment which will gradually lead to chronic pigmentation.
Treatments
Natural treatments
Melasma is a chronic hyperpigmentation disorder that greatly affects the psychological state of the patient. For most patients, melasma is a huge aesthetic problem, which also causes several problems related to self-confidence.
The treatment of melasma is long-term, it can last 3-6 months, and it often happens that the treatment does not achieve the expected result. The most difficult, or the biggest challenge, is the destruction of melanosomes, more precisely the cells that produce pigment.
Conservative treatment is mainly performed with chemical peels that prevent the formation of melanosomes. In the treatment, topical preparations are also used, which essentially serve to “whiten the skin”. After 5-7 days, the first results can be seen. During treatment, patients usually complain of dry skin, a burning sensation, and accompanying redness.
Beta carotene
A member of the carotenoid family, beta-carotene is a powerful antioxidant. The compound also contains an extremely high level of vitamins. These two properties combine to make it effective for treating the discoloration associated with melasma. Also, when applied locally, it relieves skin inflammation, and it is also called a “pregnancy mask”. Local application of natural ingredients and even food supplements can greatly help in the treatment of melasma.
Lemon juice
The citric acid in lemon juice acts as a natural exfoliant, removing dead skin cells and stimulating the growth of new, healthy skin cells. Also, lemon juice can help reduce pigmentation in melasma.
However, lemon juice for melasma can be very acidic and can cause skin irritation or sensitivity in some people, especially those with sensitive skin. It can also increase sensitivity to sunlight, so it is important to avoid sun exposure after applying it to the skin.
Aloe vera
Aloe vera has moisturizing, anti-inflammatory, and healing properties useful for skin conditions, including melasma. In addition to its moisturizing and anti-inflammatory properties, aloe vera contains compounds that can help inhibit melanin production. By reducing the production of melanin, aloe vera can help reduce the appearance of dark spots and other blemishes on the skin.
Makeup Removal
Make-up removal and face wash products are the beginning of every care. There are a lot of them on the cosmetics market, so to choose the best one for you, it is worth checking the INCI/Ingredients composition.
Exfoliation
It is worth remembering that skin with a tendency to discoloration does not like strong cleansing gels/foams/soaps, so choose mild cleansing substances and strong active substances in your care. Additionally, once a week you can extend your care with an enzyme/acid peel. Exfoliating the skin is a very important element of the skincare routine. If you want to do it regularly, it is worth choosing a product with azelaic/lactic/mandelic acid or enzymes.
Treatments with skincare products
Several topical medical or skin care products have also become available in recent years as an alternative for regulating skin color. They usually contain one or more of the following ingredients:
First of all, a cream with an SPF50+ filter is the most important cosmetic in your care.
Sunscreen creams reduce the effects of photoaging, preventing the formation of new discolorations, and minimizing the destruction of collagen and elastin fibers – an anti-aging effect. Due to UVA radiation, which reaches the Earth all year round in the same intensity – regardless of the weather, photoprotection should be used all year round.
Hydroquinone
Hydroquinone 2-4% (prescription only) – is a powerful skin whitening agent available only by prescription and banned in cosmetics in the EU due to potential toxicological risks. However, it is still used in the US. A higher concentration (> 4 %) is available only by prescription, while lower concentrations (> 2 %) are used in over-the-counter medicines.
Arbutin
Arbutin. This natural source of hydroquinone is one of the key ingredients in skin-lightening products in Asia. Although it is not as strong and effective as industrial hydroquinone, there are also questions regarding its safety.
Glycolic Acid
Glycolic acid (or hydroxyacetic acid) is an acid used by dermatologists in chemical peels and is a common active ingredient in many topical hyperpigmentation creams.
Kojic Acid
Kojic acid. A byproduct of Japanese rice wine, sake, kojic acid is a safer, natural ingredient although its effectiveness in inhibiting melanin production is disputed. This ingredient is banned in many countries.
Retinoic Acid
Retinoic acid is effective, but it can cause side effects such as irritation and excessive sensitivity to the sun (which is an existing problem for people suffering from procedural hyperpigmentation). Pregnant and nursing women should not use retinoic acid due to its possible association with birth defects.
Tranexamic acid
Tranexamic acid whose depigmenting effect in melasma was recently discovered. It is a procoagulant drug and promotes clotting by hindering plasmin. Depigmentation appears to be connected to this inhibitory effect. In this way, the drug manages to decrease the formation of arachidonic acid and, consequently, the patient will present a reduced formation of inflammatory mediators (such as prostaglandins and pro-inflammatory leukotrienes) and, subsequently, of the tyrosine enzyme which in turn regulates the formation of melanin.
Tetrahexyldecyl ascorbate
Tetrahexyldecyl ascorbate is a very stable vitamin C derivative that is 50 times more potent than regular vitamin C. Together with vitamin E and ferulic acid, they offer a strong antioxidant effect.
Ferulic Acid
Ferulic acid is a polyphenol-type antioxidant. Ferulic acid helps the skin defend itself against free radicals, which are formed when UV rays hit the skin. This prevents sun damage and other signs of oxidative stress.
It can also promote the recovery and reconstruction of already sun-damaged skin. The antioxidant has also been shown to have the ability to stabilize and enhance the effect of other antioxidants, such as vitamin E – a so-called synergistic effect.
Conclusion
The care for Melasma must be multidirectional but minimalist. Do not introduce all the ingredients at once, as skin irritation may occur. Destruction of melanosomes can lead to inflammation that can worsen melasma. To improve the condition, good cooperation between the doctor and the patient is necessary. It takes some time for the treatment to be effective, weeks, not days, and that’s why it’s important to be patient, consistent, and persistent.
