Melasma is a common skin condition characterised by the appearance of brown or grey-brown patches on the skin, primarily on the face. It typically affects areas such as the cheeks, forehead, nose, and upper lip but can also appear on other sun-exposed areas like the neck and forearms. Melasma is more common in women, particularly during pregnancy or when using hormonal therapies, and is often exacerbated by sun exposure. While melasma is not harmful, it can significantly impact an individual’s confidence and quality of life.
Melasma is classified based on the depth of pigmentation within the skin:
- Epidermal Melasma
- Pigment is located in the top layer of the skin (epidermis).
- Appears as well-defined patches with a dark brown colour.
- Often responds well to treatment.
- Mixed Melasma
- A combination of epidermal and dermal pigmentation.
- Presents as patches with varying colours and responds variably to treatment.
- Dermal Melasma
- Pigment is located in the deeper dermal layers of the skin.
- Appears as lighter brown or bluish patches with less defined edges.
- May be more resistant to treatment.
The exact cause of melasma is not fully understood, but several factors are known to contribute:
Sun Exposure
Ultraviolet (UV) radiation (both UVA and UVB along with visible blue light and infrared) stimulates melanocytes, leading to increased pigment production.
Hormonal Changes
- Pregnancy, use of oral contraceptives, or hormone replacement therapy can trigger melasma.
- Often referred to as the “mask of pregnancy” when associated with pregnancy.
Genetic Predisposition
A family history of melasma increases the likelihood of developing the condition.
Skin Type
More common in individuals with darker skin types (Fitzpatrick types III to V), as they have more active melanocytes.
Medications and Products
Certain medications, cosmetics, or topical irritants may exacerbate melasma.
While melasma can be challenging to treat, a combination of therapies and lifestyle changes can significantly improve its appearance. Treatment plans should be tailored to the individual’s skin type and the severity of the condition.
At-Home Care
- Sun Protection:
- Daily use of a broad-spectrum sunscreen with SPF 50 or higher is essential to prevent worsening of pigmentation.
- Wear wide-brimmed hats and seek shade during peak sun hours.
- Gentle Skincare: Avoid harsh or abrasive products that can irritate the skin and exacerbate melasma.
Medical Treatments
Topical Medications:
- Hydroquinone was the gold-standard treatment for lightening pigmentation.
- Other options include tranexamic acid, retinoids, azelaic acid, kojic acid, and niacinamide are now being shown to be just as effective.
Chemical Peels:
Light to medium-depth peels using glycolic acid or salicylic acid can improve epidermal melasma.
Laser and Light Therapies:
- Fractional (LUTRONICS ULTRA 1927, ALMA HYBRID, CANDELA NORDLYS 1550 & 1940, ACCLARO ULTRACLEAR) & Pico lasers (CANDELA PICOWAY) or intense pulsed light (IPL) (CANDELA NORDLYS IPL) can be used with caution for resistant cases.
- Low-energy laser treatments are preferred to minimise the risk of post-inflammatory hyperpigmentation.
Oral Medications:
Tranexamic acid, taken orally, has good benefits in reducing melasma pigment in combination with sun protection in most individuals.
Lifestyle Modifications
- Minimise exposure to UV light, high energy blue light (adjust screen settings or add a high energy blue light filter) heat (e.g. infrared saunas), and hormonal triggers where possible.
- Antioxidant-rich foods may support overall skin health.
Maintenance and Follow-Up
- Melasma often requires long-term maintenance to prevent recurrence.
- Regular follow-ups with a dermatologist ensure treatment effectiveness and timely adjustments.
For personalised advice and effective treatment options, organise a referral from your GP to streamline a consultation with our dermatology team today. Let us help you manage melasma and achieve clearer, healthier skin.
