Melasma Chloasma

Melasma and Chloasma Treatment

Melasma is a type of hyperpigmentation that is very common among Asians. They appear as symmetrical, blotchy, brownish patches on the face, and sometimes the neck, chest and even arms.

Women are at a higher chance of having melasma, the ratio of women to men having melasma is 9:1 in some studies. It’s also called chloasma, or the “mask of pregnancy,” when it occurs in pregnant women and often starts in the mid-30s, which continues to affect individuals into their 60s and beyond.

Recent studies looking at biopsies of lesioned skin in melasma patients show similarity to solar-damaged skin.

Causes

While dermatologists are still not sure as to the specific cause of this skin disorder, several factors, including pregnancy, hormonal changes, prolonged sun exposure, and hereditary predisposition, have been associated with the skin problem. Melasma can occur due to excess production of estrogen and progesterone hormones, which is produced more in women than men. Therefore, women taking birth control pills, hormone replacement therapy, or those who are pregnant are at risk of melasma as they are more likely to experience hormonal fluctuations.

Also, when the skin is exposed to the sun’s ultraviolet rays, melanocytes, the pigment-producing cells, become encouraged to produce more melanin. This situation may lead to skin discolouration or intensify existing chloasma. Those with darker skin are also more likely to develop chloasma as their melanocytes are more active.

According to experts, those with a family history of melasma are also at high risk. It is, however, important to know that having one or more of these risk factors doesn’t mean you will experience melasma, just that you are more likely to.

It isn’t totally clear what causes melasma. Darker-skinned individuals (Fitzpatrick Type 3-5) are more at risk than those with fair skin (Fitzpatrick Type 1-2).

Oestrogen and progesterone sensitivity are also associated with the condition. This means birth control pills, pregnancy, and hormone therapy can all trigger melasma. Stress and thyroid disease are also thought to be causes of melasma.

Additionally, sun exposure can cause melasma because ultraviolet rays affect the cells that control pigment (melanocytes).

Unfortunately, there is no cure for melasma. The causes a multifactorial and I will list them out in the table below

Factors that increase chance of melasma

• Asian skin type especially Fitzpatrick skin type 3 and 4
• Women
• Childbearing age
• Physically active, history of sun exposure
• Family history of melasma

Other medical conditions

• Pregnancy
• Increased female hormones;
• Oral contraceptive pills
• Hormone replacement therapy
• Childbearing age
• Thyroid disease
• Low testosterone in men

Treatment

Firstly, and most importantly, ‘recalcitrant’ melasma must be (dermatologist) diagnosed as such. ‘Recalcitrant’ means stubbornly resists, or poorly responsive to, treatment.

Unfortunately, there is no single treatment that can say; “This is the best in removing ‘recalcitrant’ melasma.”

Specific laser wavelengths have been very successful at removing melasma pigmentation. Our treatment protocol actually uses 4 different applications to reach and affect the deeper vessels and break up the pigment. A combination of Pico, Photo-Thermal, Non-Ablative fractional Lasers are used. Laser treatments are often spaced four weeks apart. We use healing LLLT following our Picoway laser melasma facial to help in better healing of the skin.

Experience shows that 8 -10 fortnightly laser treatments will ensure significant improvement and in some cases complete fading of Melasma/Chloasma. One maintenance laser treatment every 3 months is recommended to maintain achieved results with Melasma/Chloasma.

Patients with melasma also have a slightly abnormal skin barrier, so we should be hesitant in using RF or deep lasers, and aggressive chemical peels. Topical preparations – particularly triple-combination bleaching agents, retinoids, and non-hydroquinone skin lighteners – should be used sparingly and always in combination with treatments targeting skin vascularity.

Why laser treatment for facial pigmentation is so popular

I believe most of you are familiar with Q-switched lasers. These dermatological lasers became commercially available in the early 1990s and have grown wildly popular ever since.

Prior to this period, lasers were thought to be only capable of treating pigmented lesions limited to the skin surface and tattoo removal.

These lasers showed great results in the treatment of various skin pigmentation disorders, like solar lentigines (liver spots), ephelides (freckles), even deeper pigmented lesions like ABNOM (Acquired Bilateral Nevus of Ota-like Macules), and became an invaluable tool in any physician’s clinic in the treatment of pigmentary disorders.