What is Melasma and How To Cure and Treat
Melasma has become synonymous with facial pigmentation in India. It is very common in women and is also seen in some men. The pigmentation is difficult to treat and very frustrating for people who suffer from it. Many women stop socializing and go into a shell as they lose their confidence due to this pigmentation. Here, we look at the reasons behind melasma, what one can do to prevent it and also the possible treatment options.
Causes of Melasma
1. UV light: This pigmentation is light sensitive and UV exposure plays a significant role in causing the pigmentation.
2. Hormones: This is very common in women during periods of hormonal changes especially pregnancy. Women who are on hormone tablets like the contraceptive pill or hormone replacement after menopause are also prone to develop this pigmentation.
3. Genes: If the mother suffers from this form of pigmentation, it increases the daughters chances of pigmentation.
4. Diet: Sometimes a low level of vitamin D or zinc may predispose one to get this pigmentation.
Prevention for Melasma
One can reduce the chances of getting melasma by following these precautions:
1. Sunscreen use: As UV exposure is an important factor in causing melasma, it follows that using a sunscreen regularly may help prevent it. At the very minimum it will reduce the spread of the pigmentation and make it less dark and deep. It is advisable that all of us should use a sunscreen of spf 30 or more 15-20 minutes before stepping out. If staying outdoors for prolonged periods, then it is advisable to reapply the sunscreen every 2-3 hours. This becomes even more important during pregnancy and especially if your mother has melasma.
2. Avoid Hormone supplements: If you have a high risk of melasma or already have some facial pigmentation, this should be considered before starting the pill. Talk to your gynaecologist and look for an alternative contraceptive.
3. Diet: A diet which is rich in anti-oxidants (all your brightly coloured fruits and vegetables) helps maintain the health of your skin and reduce pigmentation.
4. Early check: If you do develop some pigmentation, it is advisable to see your doctor at the earliest. The doctor may recommend some blood tests like the test for thyroid function. If this is the problem, then early treatment may help minimise the pigmentation.
Treatment for Melasma
1. Sunscreen: This is the single most important factor in managing melasma. Using a sunscreen regularly and effectively will limit the spread of the pigmentation. For people who already have melasma, it is recommended that a sunscreen be used regularly indoors as well as most artificial sources of light also emit some UV light. I have deliberately duplicated this step to emphasis the importance of using a sunscreen.
2. Medicated creams: There are many creams which can be prescribed by the doctor. They usually are labelled as skin brightening creams or skin whitening creams. They contain one or more of hydroquinone, kojic acid, retinol, alpha hydroxyl acids, beta hydroxyl acids, tetrahydrocurcumin, mulberry extracts, licorice to name just a few. The vast number of potential ingredients is because none of them have guaranteed results. Using these creams in isolation or in combination with treatment procedures can help reduce the darkness and extent of the pigmentation. Some people may not respond to the first or even the second cream but almost everyone responds to some cream or the other. It is worthwhile to try the creams regularly. It is also important to use the creams regularly (over months to years). There may be no improvement in a couple of weeks- the secret to success is in persisting with the treatment.
3. Tablets: There are tree bark extracts like proanthocyanidin and some anti-inflammatories like tranexamic acid which when eaten can help treat the pigmentation. Supplements containing glutathione, L-cysteine and methionin are also available in plenty in the market. But glutathione is not absorbed when taken in tablet form.
4. Chemical peeling: This is my favourite treatment procedure for melasma. One usually fights melasma for long periods of time. Chemical peeling is gentle, easy on the pocket and very effective when used consistently. I use a combination of superficial and medium depth peels. I usually do not have a fixed number of sessions. I usually see the individual once every month and decide on the treatment for each month. This gives me the flexibility to choose the best possible peel for each month. Multiple sessions are needed and the treatment sessions often need to be followed with maintenance sessions.
5. Microdermabrasion: This is fairly similar to chemical peeling. Like a chemical peel, it takes away the dead layers of the skin. Unlike a chemical peel, this does not have any active ingredients which also penetrate into the skin. I usually reserve this for people who are not suitable for a chemical peel.
6. LASER: Several LASERs have been tried in melasma. This is an expensive option and the results are dubious. Many people with melasma actually have a worsening of their pigmentation with LASERs. Even if there is a slight reduction in pigmentation with LASERs, the cost of repetitive treatments makes it unaffordable for the majority. Although LASERs are very effective for freckles and pigmented spots that appear with ageing, I am yet to see benefits in people with melasma.
7. Mesotherapy: In this active ingredients which can hep reduce the pigmentation are injected into the skin. The active ingredients which are normally available as creams or tablets are directly placed where they are needed for maximum benefit. Very small needle is used for the injection and it is not painful. The discomfort can be further reduced by using a numbing gel before the injection. Multiple sessions are required for treatment.
The best way to manage melasma is by doing a combination of treatments and hitting the pigmentation from multiple sides. Everyone has to use medicated creams and sunscreens, some may additionally be given tablets and some may additionally go in for treatment procedures. Although frustrating to treat, with perseverance and regular treatment, the results can be satisfying.
By: Dr. Sirisha Singh
