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Is There An Effective Treatment for Melasma Removal?

What is Melasma?

Melasma is a common acquired hyperpigmentation (increase in pigmentation) disorder that is characterized by irregular brown spots and patches on the sun exposed parts of the face and less frequently, on the forearms. Although it can affect any race, melasma is more common among Asians, particularly in darker-skinned type individuals. Melasma can have a negative impact on a person’s self-esteem and quality of life.

Causes of Melasma

The cause of melasma is complex and was initially thought to involve only the melanocyte. The melanocyte is a highly specialized cell located in the base layer of the skin’s epidermis and is responsible for melanin production. Melanin is the pigment in our skin which gives us our skin colour. In general, the more melanin is in the skin, the darker the skin will be.

With more research, we now know that melasma is classically influenced by sun exposure, genetics and the female sex hormones (pregnancy, oral contraceptives, hormonal replacement therapy). Cosmetic ingredients, light-sensitising drugs, other hormonal disorders like thyroid disease can also contribute toward melasma formation.

Types of Melasma

There are three clinical patterns of melasma:

  1. Centrofacial pattern (65%) – forehead, cheeks, upper lip, nose and chin
  2. Malar pattern (20%) – Cheeks and nose
  3. Mandibular pattern (15%) – Ramus of the mandible

Picture credit: Gupta M, Doolan BJ, Manungo F, Diagnosis of melasma and diagnostic tools, Opinions & Progress in Cosmetic Dermatology 2020;1:15–18.

The melasma can also be differentiated according to the depth of the pigmentation:

  1. Epidermal Melasma – Light brown
  2. Dermal Melasma – Brown or bluish-gray under visible light
  3. Mixed Melasma – Dark-brown consisting of a mix of epidermal and dermal melasma
  4. Indeterminate or inapparent Melasma – Found in people with dark-brown skin

Treatment Options for Melasma

Due to the multifactorial nature of melasma, effective treatment methods may employ a combination of different treatments and can vary between individuals.

Sun Protection

Ultraviolet exposure is a major triggering and aggravating factor in melasma development since it is well known to stimulate the increase in melanocyte numbers and melanin production.  Using a broad-spectrum sunscreen (SPF at least 30), finding shade when outdoors and using physical protection methods e.g. clothes, wide-brimmed hat and sunglasses are recommended to prevent the development and worsening of melasma.

Laser Treatments

Q-Switched Nd:YAG Laser

The Q-switched Nd:YAG laser utilizes light wavelengths of 532nm and 1064nm to target epidermal and dermal pigmentation. A high-intensity pulsed beam energy is applied to the skin and is absorbed by the target pigment. The absorbed energy destroys the pigment without causing damage to surrounding tissues, reducing the chances of side effects and downtime.

Pro Yellow Laser

The Pro Yellow laser, which operates at 577nm light wavelength, can extend beyond the reach of the green 532nm laser to tackle redness due to deeper blood vessels. It is an effective laser to target both pigment cells and the blood vessels that supply these cells. Thus, by eliminating the blood supply to these pigment cells, the Pro Yellow laser can extend the longevity of your treatment results by suppressing melanin production.  

Chemical Peels

Chemical peels such as glycolic acid peels can be used as an adjunctive treatment modality for melasma due to their ability in increasing epidermal keratinocyte turnover. They are more suitable for treatment of epidermal melasma. Chemical peels are often used in conjunction with other topical products.

Topical Treatment

Hydroquinone is the gold-standard topical treatment for melasma. However, the risk of developing exogenous ochronosis (a bluish discolouration) and the possibility of skin irritation may make it less desirable for use among some patients.

Active ingredients commonly found in over-the-counter cosmeceuticals like resorcinol, tranexamic acid, kojic acid, azelaic acid, niacinamide have been demonstrated to show some action against pigmentation formation.

Topical Vitamin C, commonly in serum form, has been gaining popularity due to its multi-action benefits of reducing pigmentation, evening the skin tone, increasing collagen levels of the skin, reducing fine lines, and as an anti-oxidant against free radicals generated in the skin.

Recently, Cysteamine cream (Cyspera®) is a new pigment corrector that addresses the appearance of discolouration and dark spots. It has significant pigment correction with a high safety profile.

Oral Treatments

Oral Tranexamic acid

In recent years, oral tranexamic acid has been used for treatment of melasma. It blocks melanin synthesis by disrupting one of the pathways involved in melanin production. It also has an inhibitory action on the formation of blood vessels that play a role in melasma formation. A short course of treatment is recommended especially for individuals with more resistant cases of melasma.

Oral Supplements Such As Crystal Tomato

Crystal Tomato contains carotenoids which act as anti-oxidants to counter the formation of free radicals and absorb ultraviolet radiation, protecting the skin from UVA/UVB damage. They improve existing melasma spots while preventing more pigmentation from forming and protect skin from premature ageing caused by the sun.

Rejuran®

Rejuran is an injectable treatment using polynucleotides to stimulate the skin’s own regenerative capability. It has a multitude of benefits including improving pigmentation, skin tone and texture as well as increasing collagen production to rejuvenate the skin.

Due to the complex nature of melasma, there is no one-size-fits-all treatment for treating melasma. Different combinations of treatment options may be used to address it. In particular, for laser treatments it is recommended that the clinic has sufficient experience in managing the condition for a safe and effective treatment. Furthermore, you should also be informed of the various therapeutic options available before proceeding with the treatment.

Fixed an appointment with our doctors to find out your treatment options.