WHAT IS MELASMA
Melasma is a pigment problem on the face. It causes patches of dark pigmentation often on the forehead, nose, cheeks and top lip.
These patches often look like a blotchy uneven coffee or tea coloured stain and may vary from very pale to quite dark. Melasma almost universally only affects females.
Melasma is more common in darker skin types and Asian, Mediterranean, South American, Indigenous and African skin types are especially prone.
Melasma is generally hated – it makes the skin look “dirty”, can be very difficult to cover with makeup, and readily available and beautician based treatments are often ineffective.
WHAT CAUSES MELASMA
This is not well understood, but there is an increase in activity in the pigment producing cells in the skin. It can run in families and is triggered by hormones and worsened by sun exposure.
It can often be caused by the hormonal changes of pregnancy (where it is so common it is often called “the mask of pregnancy”) and by the contraceptive pill, but will often continue after the contraceptive pill has been changed or stopped and may not go completely once pregnancy is over.
HOW IS MELASMA TREATED?
Removing melasma completely is not always possible, but it can usually be significantly reduced and managed.
The good news is that most treatments are inexpensive. Laser treatments and IPL are generally ineffective, especially on their own.
They tend to clear the melasma temporarily but it almost always returns in 2-4 weeks and can be worsened.
Melasma prone skins are particularly prone to post inflammation pigment, so laser and IPL can make melasma worse.
Microdermabrasion and skin needling are also usually ineffective.
The fist cornerstone of treatment is sun care.
Sun exposure always makes melasma darker so a good sunscreen (30+ or better) must be used daily.
A cap or hat will effectively shield the forehead.
Those with dark skins may not be used to using sunscreen, but it is imperative.
The second cornerstone of treatment is an effective anti-pigment prescription grade skin care.
These are often (rather poorly) called “skin lightening” or “skin bleaching” creams.
These products actually settle the pigment producing cell activity down to a lower level.
Most creams available “over the counter” without a doctor’s prescription are rather weak and ineffective.
At Envisage Clinic Dr Leat uses a range of proven prescription ingredients such as Tretinoin, Hydroquinone, Niacinamide and Kojic Acid in compounded creams and/or the Ultraceuticals “Ulta MD” doctor only range and generally is able to obtain very good results.
Effectively treated melasma will fade over a number of weeks – in the same way that a skin tan fades over time.
In some patients skin peels and even gentle IPL are used as a third line option, but only after the skin has been prepared as above.
I HAVE MELASMA – SHOULD I STOP THE PILL?
Hormones such as are in the contraceptive pill are certainly a factor in causing melasma.
Unfortunately stopping the pill will not always reduce the melasma, and may put you at risk of an unwanted pregnancy.
It may be worth switching to a lower dose pill or changing to an alternative form of contraception, but you should discuss this with your doctor first.
I’M PREGANANT AND HAVE MELASMA – WHAT SHOULD I DO?
Most of the prescription based and effective skin care treatments are contra-indicated during pregnancy, and IPL and laser can make the problem worse, especially during pregnancy, so options are limited.
Certainly be very careful with the sun – limit exposure as much as possible, always using a high factor sun screen every day, and wear a hat outdoors.
Melasma will generally fade after your pregnancy is over, but may not go completely, so that is the time to make an appointment and come in.
YOUR NEXT STEP
Why not take action against melasma today and start your journey to clearer skin.
Envisage Clinic appointments are free or bulk billed so there is no cost to discover what your options are. Call us on 5539 4000
Article by Dr Christopher Leat – Medical Director Envisage Skin Clinic
Founder and Director, Dr Christopher Leat has 33 years’ experience in Medicine and is a member of The Royal College of Physicians of London.
Dr Leat has devoted the last 18 years to Cosmetic Medicine and is recognised throughout Australia as one of the most experienced doctors in the field of Cosmetic Medicine.
To book an appointment with Dr Leat call 07 5539 4000
