Pigmentation

Pigmentation

'known as Melasma'

Melasma is a common skin problem.  The condition causes dark, discoloured patches on your skin. It is also called chloasma or the ‘mask of pregnancy’, when it occurs in pregnant women, fortunately, for the majority of women, fading after delivery. However, in some women, it does not fade.

The condition is much more common in women than men, though interestingly, it is occasionally seen in men, especially in those with olive or darker complexions from Southern Europe, the Middle East or Asia.

Melasma causes patches of discolouration.  The patches are darker than your usual skin colour.  It typically occurs on the face and is symmetrical, with matching marks on both sides of the face.  Other areas of your body that are often exposed to the sun can also develop melasma. The commonest sites for Melasma to appear are on the forehead, cheeks, bridge of the nose, and chin.

It can also occur on the neck and forearms.  The skin discolouration doesn’t do any physical harm, but may you may feel self-conscious about the way it looks.

How is it caused?

In the majority of women, the condition is caused by ultraviolet light acting on sensitised pigment-producing cells (called melanocytes) in the skin. Oestrogen hormones appear to render the pigment-producing cells in certain areas of the face more sensitive to ultraviolet light.  When these sensitised cells are then exposed to sunlight, they are stimulated to produce excessive melanin pigment, hence the pigmentation.

In males (in whom low levels of oestrogen hormone are normally present) and those women without an obvious excess of oestrogen hormone, it has been suggested that in these circumstances, the melanin-producing pigment cells (the melanocytes) become sensitised by the body’s normal levels of circulating oestrogen hormone and start to produce excess melanin pigment when exposed to ultraviolet light.

Treatment

The treatment of Melasma can prove equally disheartening for both patients and professionals but newer treatment strategies have been encouraging in terms of better control and in some cases permanent removal of the pigmentation

Based on the very way Melasma develops, it is impossible to predict which patients will respond successfully to treatment and be rid of their Melasma permanently, and who will relapse.  There are creams your doctor can prescribe that can lighten the skin.  They might also prescribe topical steroids to help lighten the affect areas.  If these do not work then there are other possible treatment strategies.

Accordingly, patients must approach any treatment for Melasma realistically and accept the possibility that recurrences could occur and require further treatments.

Treatment strategies and options for Melasma

  • Hormones: If possible, stop any hormone replacement therapy.  If you are taking the oral contraceptive pill to consider stopping it in favour of another method of contraception, always consult your general practitioner before ceasing any medication.
  • Avoid UV Exposure & Use Physical Barrier-Type Sunscreens: Our Cosmetologist will advise on how to more effectively prevent UV exposure as well as the best sunscreens to buy.
  • Depigmenting Lotions: These are effective when being applied because they inhibit the chemical conversion that produces the melanin.  However, as soon as the lotion is stopped, the chemical conversion resumes and the Melasma returns.
  • Medium Depth Chemical Peels can be tried but recurrence is more common than a permanent cure.  However, long-standing clearances of Melasma have been reported after two Medium Chemical Peels done in reasonably quick succession.
  • Pigment-Targeting Lasers can sometimes be very successful.
  • Medical-Grade Micro-Dermabrasion, have been able, with repeated treatments, to eventually bring about a total and permanent removal of the Melasma in a number of our patients.