11 March 2015

Minimising melasma made easy

If you have brown patches around the cheekbones, it could be melasma. Melasma is a common skin condition that causes brown to gray-brown patches of skin on the body due to over-production of melanin, a natural substance that gives colour to skin, hair and eyes. Melasma usually appears on exposed areas of the body such as the face, although it can also develop on the forearms and neck. 

According to Dr Calvin Chan of the Aesthetic & Laser Clinic in Singapore, there are two types of melasma, an epidermal (the top layer of skin) variation, and a dermal (the middle layer of skin) variation, but that people may experience both types at the same time. 

"I have a visual imaging system which has a built-in UV camera to help with diagnosis," Dr Chan said. "In the epidermal type, the pigmentation appears more intense, whereas with the dermal type, the pigmentation appears the same."

Common triggers for melasma, he added, can include sun exposure, pregnancy, birth control pills, cosmetics and genetic predisposition. "If your mother has melasma, you are more likely to have melasma as well," Dr Chan said, observing that it is more common in people with darker skin. "Melasma is not harmful but it does affect patients psychologically."

Dr Chan noted that there are creams for the skin formulated to treat melasma*. "Over-the-counter treatments usually include ingredients like arbutin, vitamin C and kojic acid. Prescription topical treatments include tretinoin, hydroquinone, and there’s an FDA-approved cream that contains 4% hydroquinone, 0.05% tretinoin and 0.01% fluocinolone acetonide. We know that tretinoin helps with increasing epidermal cell turnover, hydroquinone inhibits melanin synthesis (Editor's note: the production of melanin) and fluocinolone acetonide also inhibits melanin secretion and synthesis," he said.

Dr Chan observed that melasma can be treated successfully, but not as easily as with other pigmentation problems. "One common misconception is that melasma can be treated the same way other types of pigmentation like freckles, which can be treated for example with intense pulsed light (IPL) and lasers among other treatments," he said. 

"Unfortunately, in some cases the heat from laser and IPL treatments can sometimes cause melasma to surface or worsen, so the skin needs to be primed first with topical lightening agents and any treatment plan involving light or laser sessions needs to proceed cautiously to prevent inadvertently worsening the condition. 

"Another misconception is that it can be eradicated completely. This is often not the case as melasma, apart from being notoriously difficult to treat, also tends to recur as the underlying causes, genetics, hormonal changes etc. tend to persist."

Dr Chan advised those who would like to minimise the likelihood of getting melasma to avoid the sun. "As you know, sun exposure is a trigger for melasma, so using a broad spectrum UVA, UVB sunscreen that is at least SPF 30 and above will help if reapplied every four hours. Avoid the sun between 10am and 4pm, and wear a wide-brimmed hat and protective clothing. Avoid harsh skin products and use a gentle skin cleanser and moisturiser. Always see a doctor for accurate diagnosis and treatment," he said.

*Healthcare professionals should always be consulted for advice on treating melasma.