Melasma Treatment

Melasma is a very common disorder for women, particularly women who are pregnant, using patch/ oral contraceptives, or using hormone replacement therapy medication. The disorder appears as a dark or tan spots on the face. An increase in estrogen or progesterone causes an increase in melanin. 

Occasionally, referred to as a “pregnancy mask,” the dark patches commonly develop on the cheeks, forehead, nose, lips, upper lip, and nose. Women with tan skin tones and women living in areas with an intense amount of sun exposure are more predisposed to this condition. Occasionally, yet rarely, melasma can outbreak with those who have thyroid disease due to stress, and allergic reactions to external triggers such cosmetics or medications can also induce melasma.

The brown spots are not harmful, but may cause cosmetic concerns. Limiting sun exposure is key to treating melasma. Our practice also treats this hyperpigmentation with a series of topical treatments and laser therapy. We prefer to use the Pixel® or Active FX™ laser, both performed in office with little downtime.

LASER MELASMA TREATMENT

Even the most challenging cases of melasma, occurring in darker skinned women, can be effectively treated with AMA Regenerative Medicine & Skincare’s advanced laser protocols.

K5 Lipogel treatment postnatal like? Treatment for postnatal burns

Hormonal changes, the skin also causes skin problems such as uneven skin color, easy to acne but the most basic is still tan.

Postpartum birth occurs due to a woman's hormonal changes. Skin lesions appear due to melanin pigmentation changes of the skin. Essentially, postnatal pigmentation is a normal physiological phenomenon. Some people, after birth will be able to disappear but there will also be a permanent appearance, even more and more color and thickening. As a result, postnatal treatment or skin tanning generally requires prevention, prevention and early treatment.

As mentioned, mothers will be very interested in products after treatment K5 Lipogel. I want to confirm that this is the only skin pigmentation product that impresses me when undergoing clinical trial, test on many women with skin pigmentation both before and after birth.

The results make me quite impressed. Although I am not a pharmacist, I do not study anything in the pharmaceutical industry, but you know, any product that is clinically proven reflects both: (1) It is a quality product because only the quality they (the manufacturer) dare to do clinical test results because not all products can be tested due to expensive costs, according to himself known. (2) the manufacturer is quite confident in the quality of the product and should be proven effective.

With any product, if you want to test your ability and quality, take a look at its research.

In addition, anyone who treats melasma is known as the Hydroquinone - the classic whitening cream of the skin right? I know that I know that, this substance is found in many treatment products that are very small in size. The products that we see are listed as prescribed and prescribed by the doctor. Seeing that, I began to explore further and I realize that this ingredient absolutely needs to be used according to the specified requirements because this active ingredient can cause unwanted side effects.

So I decided not to use the product containing this substance because I also do not know much about pharmaceuticals, cosmetics can not strictly follow the instructions of the doctor. As you know, in Vietnam, the use of melasma treatment products is usually prescribed by the doctor. (haha)

So I kept contemplating how to find out the product K5 lipogel burns. This product was found by the manufacturer to be the second generation of Hdroquinone. Pidobenzone active in K5 Lipogel is preserved in nature as Hydroquinone, which is safer without any side effects.

The ability of Pidobenzon is to remove the links of melanin without creating any side effects to the skin. That's why I bought this product right away.

The first is that I use only a small amount to test, no real side effects. After that, I applied on a large area, about 2-3 days later, the skin is quite dry, the skin is dry than other areas of skin. A few days later, the skin is peeling off. I see so much melanin treatment should not be anything.

Then, you see, I continue to use the same as the advertising said. 2 - 3 weeks later, it burns out. I keep using it now is almost 2 months already. The spots also fade away.

However, you need to be aware not to worry too much, just create a comfortable psychological; Eat plenty of green vegetables and fruits, supplement with vitamin C, E ... I also recommend that you apply face cream regularly because the cream melasma is dry skin.

TOPICAL TREATMENT OF MELASMA

Abstract

Melasma is a common hypermelanotic disorder affecting the face that is associated with considerable psychological impacts. The management of melasma is challenging and requires a long-term treatment plan. In addition to avoidance of aggravating factors like oral pills and ultraviolet exposure, topical therapy has remained the mainstay of treatment. Multiple options for topical treatment are available, of which hydroquinone (HQ) is the most commonly prescribed agent. Besides HQ, other topical agents for which varying degrees of evidence for clinical efficacy exist include azelaic acid, kojic acid, retinoids, topical steroids, glycolic acid, mequinol, and arbutin. 

Topical medications modify various stages of melanogenesis, the most common mode of action being inhibition of the enzyme, tyrosinase. Combination therapy is the preferred mode of treatment for the synergism and reduction of untoward effects. The most popular combination consists of HQ, a topical steroid, and retinoic acid. Prolonged HQ usage may lead to untoward effects like depigmentation and exogenous ochronosis. The search for safer alternatives has given rise to the development of many newer agents, several of them from natural sources. Well-designed controlled clinical trials are needed to clarify their role in the routine management of melasma.

Introduction

Melasma (from the Greek word, ‘melas’ meaning black) is a common, acquired, circumscribed hypermelanosis of sun-exposed skin. It presents as symmetric, hyperpigmented macules having irregular, serrated, and geographic borders. The most common locations are the cheeks, upper lips, the chin, and the forehead, but other sun-exposed areas may also occasionally be involved. The term, “chloasma” (from the Greek word, ‘chloazein’ meaning ‘to be green’) is often used to describe melasma developing during pregnancy; however, as the pigmentation never appears to be green, the term, “melasma” should be preferred.

Although melasma may affect any race, it is much more common in constitutionally darker skin types (skin types IV to VI) than in lighter skin types, and it may be more common in light brown skins, especially in people of East Asian, Southeast Asian, and Hispanic origin who live in areas of the world with intense solar ultraviolet exposure. Melasma is the most common pigmentary disorder among Indians.[1]. It is much more common in women during their reproductive years but about 10% of the cases do occur in men. The clinical and histological features of melasma in men are the same as those of melasma in women.[2]

Pathophysiology of Melasma

The pathophysiology of melasma remains elusive, but multiple factors have been implicated. The role of female hormonal activity has been suggested by the increased frequency of occurrence of melasma in pregnancy and in those on oral contraceptive pills, estrogen replacement therapy, and estrogen treatment for prostatic cancer. The mechanism of induction of melasma by estrogen may be related to the presence of estrogen receptors on the melanocytes that stimulate the cells to produce more melanin. Genetic factors are indicated by familial occurrence of melasma and its increased incidence in people of Asian and Hispanic origins. Other factors implicated in the etiopathogenesis of melasma are photosensitizing and anticonvulsant medications, mild ovarian or thyroid dysfunction, and certain cosmetics. One of the most important factors in the development of melasma is ultraviolet exposure from sunlight or other sources. Exacerbation of melasma is universally seen after prolonged sunexposure but the pigmentation fades after periods of avoidance of sunexposure. Whatever the mechanisms, melasma results in an increased deposition of melanin in the epidermis, in the dermis within melanophages, or both. The number of melanocytes in the lesions has been variably reported to be normal[3] or increased.[4] The melanosomes within the melanocytes and keratinocytes have been reported to be increased in size.[3,4]

Types of Melasma

The lesions range in color from light brown to dark brownish-black and affect the regions of the face in different patterns. Three clinical patterns of distribution of the pigmentation may be recognized: Centrofacial, malar, and mandibular.[5]

The centrofacial pattern is the most common and involves the cheeks, nose, forehead, upper lip, and chin. The malar pattern involves the cheeks and nose. The ramus of the mandible is involved in the mandibular pattern. Melasma does not involve the mucous membrane.

With the help of Wood's lamp examination, melasma may be classified into four histological types according to the depth of pigment deposition[6]. The epidermal type is the most common in which the pigmentation appears more intense under Wood's lamp examination. Melanin is distributed throughout the epidermis; topical treatment may work best in this type of melasma. In the dermal type, the pigmentation is not intensified with Wood's light. The pigmentation is due to plenty of melanophages in the dermis. In the mixed type, Wood's light intensifies pigmentation in some areas while other areas remain unchanged. The pigmentation is due to increased epidermal melanin as well as dermal melanophages. Wood's lamp examination is of no benefit in very dark individuals, and this type is classified as indeterminate. This classification may partly work in lighter skin types but not in brown or black skin types.[7] Moreover, there may not be good correlation between the findings of Wood's lamp examination and histological depth of pigmentation.[7]

Depending on the natural history of the lesions, melasma may also be classified into transient and persistent types.[7] The transient type disappears within one year of cessation of hormonal stimuli like pregnancy or oral contraceptive pills. The persistent type continues to be present more than one year after the hormonal stimulus is removed and is caused by the action of UV rays and other factors, highlighting the role of sun-avoidance in the management of melasma.

Topical Treatment

By causing cosmetic disfigurement of the face, melasma is frequently associated with a significant emotional effect. There is no universally effective specific therapy for the disease—existing agents have varying degrees of effectiveness, and the condition, more often than not, relapses.[8] Most cases are treated with topical agents, used alone, or in combinations. Other modalities of treatment utilized in the management of this hypermelanotic disorder are chemical peels and physical therapies in the form of various lasers or intense pulse light sources. All patients with melasma should be counseled about the natural course of the disease and the necessity for adherence to a long-term treatment plan. Careful history about the possible precipitating or aggravating factors must be taken with special attention to the intake of oral contraceptives or other hormonal preparations, phototoxic and anti-seizure medications, and the usage of cosmetics. 

Discontinuation of oral pills and avoidance of scented cosmetics is advised. Recurrence of melasma occurs on exposure to sunlight and other sources of ultraviolet rays. Photoprotective measures like the avoidance of direct sun-exposure and the regular use of a broad-spectrum sunscreen are always advised, although clinical studies on their role are lacking. Treatment with demelanizing agents must be continued for several months before significant clinical benefits become noticeable. Topical agents are much more effective in the epidermal type of melasma.

Melasma Treatment & Management

Medical Care

Melasma can be difficult to treat. The pigment of melasma develops gradually, and resolution is also gradual. Resistant cases or recurrences of melasma occur often and are certain if strict avoidance of sunlight is not rigidly heeded. [14] All wavelengths of sunlight, including the visible spectrum, are capable of inducing melasma. The best treatment remains a topical combination hydroquinine cream, sun avoidance, and no estrogen exposure. Boosters are only of limited benefit. A chemical peel or laser treatment may help in about a third of cases, a third of cases remain the same, and another third show hyperpigmentation. [15]

Prophylactic management is often the most effective means of prevention. Avoidance of sun exposure and use of high-SPF sunscreens (50+) can prevent the development of melasma. In one study of 200 Moroccan women who applied SPF-50+ sunscreen daily during pregnancy, less than 3% developed melasma. Although the study did not include its own control arm, this is well below the established rates of development in pregnancy (15-50%). [16]

The role of oral contraceptives in the development of melasma has been clearly defined, especially in women without a family history of the condition.

Therefore, discontinuation of these medications and avoidance of oral contraceptive pills in the future is recommended when possible in women who have onset of melasma after starting these drugs.

The mainstay of treatment for melasma remains topical depigmenting agents. Hydroxyquinone (HQ) is a classic and still commonly used first-line agent, both alone and when combined with other agents, although there are concerns regarding adverse effects with long-term use [17] It is a hydroxyphenolic chemical that inhibits tyrosinase, the enzyme that converts L-tyrosine to L-DOPA and the rate-limiting step in the pathway of melanin synthesis. Additionally, cytotoxic metabolites may cause interference with melanocyte function and viability. HQ can be applied in cream form or as an alcohol-based solution.

Concentrations vary from a 2% concentration available in the United States without a prescription to a standard 4% concentration and even higher when compounded. Efficacy is directly linked to concentration, but the incidence of adverse effects also increases with concentration. All concentrations can lead to skin irritation, phototoxic reactions with secondary postinflammatory hyperpigmentation, and irreversible exogenous ochronosis (reported even with long-term use of 2% HQ). Special care must be taken not to prescribe the monobenzyl ether of HQ (Benoquin), which causes an irreversible localized and generalized vitiligolike leukoderma. Outside the United States, topical creams with concentrations as high as 8% are available over the counter. These agents are associated with much higher rates of exogenous ochronosis and should not be used.

In recent years, concerns have been raised about the potential carcinogenic properties of HQ. This is based on the observation that hepatic metabolism of this agent results in the production of benzene derivatives during hepatic metabolism. In the case of topical application of HQ, this does not appear to be a concern, as the vast majority of metabolism of topically applied HQ is metabolized in the vascular system and renally excreted. [18] This knowledge has led to concern that free-radical metabolites could induce acute or chronic kidney injury; however, no association has been demonstrated in the 50+ year history of HQ’s use as a topical solution. [19] To date, all concerns regarding HQ’s potential toxic effect are considered speculative.

The use of topical retinoids (trans-retinoic-acid) can be effective as monotherapy. These agents are derivatives of vitamin A and lead to increased keratinocyte turnover and decreased melanocyte activity. They also increase the permeability of the epidermis, allowing for better penetration of adjunct therapies. [20, 21]

Care must be taken with these agents, however, as retinoids are known teratogens. It is essential to avoid prescribing systemic retinoid therapy to pregnant patients or patients attempting to become pregnant. Additionally, although there is no evidence that topical retinoids are associated with congenital malformations, pregnant patients should be counseled concerning the risks and benefits of treatment for a cosmetic condition. The response to treatment with topical retinoids is also less than that with HQ and can be slow, with improvement frequently taking 6 months or longer.

Owing to tretinoin’s ability to increase the effectiveness of other therapies, combinations of tretinoin with HQ, with or without a topical corticosteroid, have been promoted. [20] In fact, the only topical ointment currently approved by the US Food and Drug Administration (FDA) for the treatment of melasma is a triple-combination cream, a composite of hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (Tri-Luma). Comparative studies of the effectiveness of the triple-combination cream versus topical HQ suggest that the combination cream is faster and more effective at reducing melasma pigmentation, but it does carry a slightly increased risk of an adverse reaction. [22] A 2010 study found that the triple-combination cream is safe and effective when used intermittently or continuously for up to 24 weeks. [23]

The major adverse effect of tretinoin is mild skin irritation, especially when the more effective, higher concentrations are used. Temporary photosensitivity and paradoxical hyperpigmentation can also occur. Tretinoin is believed to work by increasing keratinocyte turnover, thus limiting the transfer of melanosomes to keratinocytes. Adapalene is a synthetic retinoid analog that may be an alternative to tretinoin. A study in Asian Indian patients compared adapalene 0.1% topical to 0.05% tretinoin. After 14 weeks, reduction in MASI scores were equivalent between the two therapies, while the adapalene group developed fewer adverse effects and reported better tolerance to the therapy. [24]

Azelaic acid, available as a 20% cream-based formulation, appears to be an effective alternative to 4% HQ and may be superior to 2% HQ in the treatment of melasma. [25, 26] The mechanism of action is similar to that of HQ, but, unlike HQ, azelaic acid seems to target only hyperactive melanocytes and thus will not lighten skin with normally functioning melanocytes. The primary adverse effect is skin irritation. No phototoxic or photoallergic reactions have been reported.

Other depigmenting agents that have been studied in the treatment of melasma are 4-N -butylresorcinol, phenolic-thioether, 4-isopropylcatechol, kojic acid, and ascorbic acid. [27] It has been suggested that taking an oral proanthocyanidin (a class of flavonols) along with a vitamin regimen may significantly reduce pigmentation. At this time, the mechanism for this treatment method is not fully understood. Significantly more study is necessary before this method of treatment could be deemed effective. One major benefit to this mode, however, is that the use of proanthocyanidin is a natural treatment method, and it is a safe alternative in patients who exhibit a moderate or severe adverse reaction to a topical treatment. [28]

In an attempt to search for a new treatment for melasma, Wu et al studied oral administration of tranexamic acid (TA) in Chinese patients. Tranexamic acid tablets were prescribed to 74 patients at a dosage of 250 mg twice daily for 6 months. At follow-up, more than half of patients (54%) showed good results. This treatment may be effective for some patients, but further study is needed. [29]  Other reports have also described sucessful treatment with oral TA. [30, 31]

The Differences Between Melasma and Typical Hyperpigmentation and How to Treat Them

Acne scarring. Sun damage. Inflammation lingering from an eczema flare-up. Hyperpigmentation, a broad term that refers to a skin condition in which the skin is discolored or darkened, can be brought on by many different factors.

But, as it turns out, there's a type of hyperpigmentation that you may have never heard of until now. It's known as melasma, and it's a pigmentary condition that affects more than five million Americans, most of them being women. Much like general hyperpigmentation, melasma appears in the form of discoloration on the skin and is exacerbated by exposure to the sun. However, there are actually quite a few differences that set it apart from your run-of-the-mill hyperpigmentation (which we'll get into, don't worry).

While no one should ever feel like they have to hide a skin ailment, it's important to know the differences between the two conditions if you choose to treat them. Ahead, a definitive breakdown of melasma and hyperpigmentation, the differences between the two, and how to treat them — as detailed by four trusted dermatologists.

Hyperpigmentation can refer to any darkening of the skin.

Whether you have post-blemish scarring from a stubborn breakout, freckles that expanded into full-blown sun spots from excess exposure, or discoloration caused by a condition like eczema or psoriasis, the discoloration usually all falls under the umbrella of hyperpigmentation. This is because acne, sunlight, skin rashes, and the like have the potential to stimulate melanocytes, the pigment-making cells in the skin, to make a surplus of pigment, "causing them to dump their pigment into lower levels of the skin, like tattoo pigment, where it doesn't belong," explains Adam Friedman, an associate professor of dermatology at George Washington University Medical Faculty Associates in Washington, D.C.

The deeper the pigment, the tougher it is to treat. Put it this way: A section of skin that's been consistently exposed to harmful UV rays without the proper protection will be harder to diminish than say, a dark spot leftover from a pimple that you've been careful to shield from the sun. In other words, the level of severity varies, but if you spot discoloration on your skin that wasn't there before, it's safe to assume it's hyperpigmentation. But always consult your doctor to be sure, of course.

Melasma is in a league of its own.

Melasma is a form of hyperpigmentation that's more commonly seen in women (especially in those with darker skin tones) and is thought to be triggered by UV exposure, as well as hormonal influences. The latter is what distinguishes it from traditional hyperpigmentation and makes it tougher to treat. "Hormonal influences play a significant role here, as seen by the increased prevalence of pregnancy, oral contraceptive use, and other hormonal therapies," says Friedman. "The problem is preventing its worsening, especially from the hormonal angle, as it can be hard to remove the instigating factors."

You can usually tell if you have melasma based on its appearance alone. "[It] typically appears as symmetric blotchy hyperpigmented patches on the face, usually the cheeks, bridge of the nose, forehead, chin, and upper lip," says Sejal Shah, a dermatologist and founder of Smarter Skin Dermatology in New York City. While less common, melasma can appear on other parts of the body — especially those more prone to sun exposure (like the neck and forearms) — and many people say their melasma worsens in the summer and improves in the winter. "It may [also] appear during pregnancy or after starting birth control or other hormonal treatments," Shah says. (Something to consider if you've seen discoloration appear shortly after switching up your birth control or undergoing a hormonal change.)

Melasma and Everything

Melasma, also called ‘chloasma’, is a common skin condition of adults in which light to dark brown or greyish pigmentation develops, mainly on the face. The name comes from melas, the Greek word for black. Although it can affect both genders and any race, it is more common in women and people with darker skin-types who live in sunny climates. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection, it is not contagious and it is not due to an allergy. Also, it is not cancerous and will not change into skin cancer.

What causes melasma?

The exact cause is not known, but several factors contribute. These include pregnancy, hormonal drugs such as the contraceptive pill, and very occasionally medical conditions affecting hormone levels. Some cosmetics, especially those containing perfume, can bring on melasma. There is research to suggest that it can be triggered by stress. Sunshine and the use of sun-beds usually worsen any tendency to melasma.

Is melasma hereditary?

Melasma can run in families, suggesting an inherited tendency.

What does melasma look like?

Melasma is simply darker-than-normal skin affecting the cheeks, forehead, upper lip, nose and chin, usually in a symmetrical manner. It may be limited to the cheeks and nose or just occur overlying the jaw. The neck and, rarely, the forearms can also be affected. Areas of melasma are not raised.

What are the symptoms of melasma?

It is the cosmetic aspect of melasma that affected people tend to find upsetting. The affected skin is not itchy or sore.

How is melasma diagnosed?

Melasma is usually easily recognised by the characteristics of the pigmentation and its distribution on the face. Occasionally, your dermatologist may suggest that a small sample of skin (numbed by local anaesthetic) is removed for examination under the microscope (a biopsy) in order to exclude other diagnoses.

Can melasma be cured?

No, at present there is no cure for melasma, but there are several treatment options which may improve the appearance. Superficial pigmentation is easier to treat than deep pigmentation. If melasma occurs during pregnancy, it may resolve on its own within a few months after delivery and treatment may not be necessary.

To fnd out about available treatments for Melasma, please go to this page on the British Association of Dermatologists website.