Our favourite dermatologist Dr. Lev Naidoo helps us understand what we need to know about melasma hyperpigmentation. She discusses what it is, how to recognise it, the latest research, and how to treat it.
What is Melasma?
Melasma – sometimes called chloasma or the mask of pregnancy – is a common, acquired disorder of increased pigmentation that affects many people worldwide.
How does Melasma appear?
Typical signs of melasma are light to dark brown patches of increased pigmentation distributed evenly on the face, with irregular borders. It is usually found over the cheeks and/or forehead, bridge of nose, chin and jaw areas. One of the telltale signs of this condition is that it almost always becomes worse during summer.
In past medical studies, melasma was defined as either epidermal (superficial), dermal (in the deeper layers of the skin), or mixed (both in the epidermis and the dermis), based on how the melanin pigment was deposited in the skin. More recent studies show that all melasma is mixed.
Who gets Melasma?
Melasma affects most people twenties and thirties. It is seen earlier in lighter skin types than in dark skins, and melasma in men is more common as once believed.
What are the risk factors for Melasma?
Whether you will develop melasma or not depends on factors such long-term exposure to ultraviolet (UV) light from the sun and light sources, so people who tan or spend a lot of time outdoors playing sport are more likely to develop it. Female hormone stimulation (see below) affects it too, and then there’s genetic predisposition – did your mother and aunts have it?
Some people also report that melasma develops or worsens after stressful events that have generated anxiety. The reason for this is that stress and depression raise levels of cortisol. This stimulates certain hormones that cause an increase in melanin production.
What causes Melasma?
Our understanding of melasma has evolved. We used to think of it as a “simple” disturbance of melanocytes, the cells that produce melanin pigment. However, recent analysis revealed almost 300 genes are significantly different, when comparing melasma areas to surrounding healthy skin. This affects the pigment-producing melanocytes and also the dermis. It also, unfortunately, makes the treatment of melasma complicated and ongoing – a lifelong commitment.
Recent data also backs the theory that melasma is partly a photoageing disorder – UV damage-induced premature skin ageing.
It’s UV damage
Long-term UV exposure also raises the levels of matrix metalloproteinases in the skin, which degrade collagen. Collagen is an important component of the membrane separating the epidermis from the dermis. When this membrane is degraded, melanocytes and melanin are able to enter into the dermis. This deeper deposit of melanin makes treatment more challenging.
Our oil glands play a part
Oil-producing sebaceous cells also contribute to melasma. This may be why we find melasma in the centre of the face, where sebaceous glands are more densely distributed.
Of course, free radicals have to be involved
People with melasma have higher levels of oxidative stress (an imbalance of free radicals and antioxidants), compared to people without melasma. This leads us to think there may be a connection between free radical injury and melasma.
And then we have our hormones, but all is not what it seems…
For a long time, we believed our female hormones played a part in melasma. A recent study of melasma patients in nine countries, however, minimises the impact of female hormones. It showed that the onset of melasma occurrs in only 20% of cases per pregnancy. Almost 10% of melasma start after menopause. The same study also showed that there wasn’t a significant slowing of melasma once the trialists stopped using contraceptive pills.
It seems cortisol hormones may be at least partly responsible.
Recent research shows the importance of the role of cortisol hormones in melasma. As explained above, the hypothalamus controls the release of melanin-stimulating cortisol, which have a direct effect on pigmentation. The hypothalamus’s role in the limbic system that governs our emotions supports the theory that emotions and stress reactions can cause increased pigmentation in certain people.
How do you treat Melasma?
1. Start developing sun protection habits.
Limit time spent outdoors when sun is at its peak.
Try to use protective clothing and sunhats with a wide brim.
Use sunscreen every day. And reapply every two hours if you are spending long periods of time outdoors or in water.
Current studies show that physical blocker sunscreens (e.g., sunscreens with titanium dioxide or zinc oxide), or combination chemical-filter and physical blocker sunscreens are more effective than chemical filter sunscreens alone in protecting against visible light. These increase the sunscreen’s photoprotective capacity which, in turn, increases the success of melasma treatment.
The sunscreen I often recommend for my melasma patients is Bioderma’s Photoderm M, which combines both chemical and physical blockers. It is fragrance-free, doesn’t block pores and is excellently tolerated even by sensitive skin-types. Its very high UVA/UVB protection has titanium dioxide to protect against visible light. It also contains glabridin, which inhibits stimulation of melanin production.
2. Use a pigmentation-correction treatment
I find products with a combination of pigment-inhibiting ingredients offer the most benefit. It is also important that it offers barrier repair to address the photoageing component of melasma. Addition of an antioxidant further strengthens the capacity for correction.
Products I recommend for my melasma patients include:
Esthederm’s Esthe White Brightening Youth Anti-Dark Spots Serum: A combination of licorice root extract inhibits melanin production, neoglucosamine further inhibits melanin synthesis and is a building block for hyaluronic acid, helping with skin repair. The antioxidants vitamin C, E and superoxide dismutase decrease free radicals, regulate melanocyte activity and decreases inflammation in the skin. Apply this product twice daily to areas with increased pigmentation.
Noreva’s Iklen Mélano Expert Anti-Brown Spot Concentrate contains rucinol and Sophora-α, which inhibit melanin synthesis, centaureidine, which inhibits the migration of melanin to the keratinocytes, as well as Vitamin C.
Le Beauty Club comment: Suitable for use while pregnant and breastfeeding.
Bioderma’s new Pigmentbio Night Renewer – this powerhouse product contains a combination of niacinamide (the biologically active form of vitamin B3 which decreases the transfer of melanosomes from melanocytes to keratinocytes and enhances barrier repair), azelaic acid inhibits tyrosinase and decreases inflammation. It also contains other ingredients effective in treating pigmentation – licorice root extract, vitamin C. Vitamin E and vitamin PP strengthen the skin’s barrier. Apply this product in the evening to areas of pigmentation.
3. Additional support
Beyond anti-pigmentation skin care, you can also improve pigmentation problems with chemical peels, microdermabrasion and micro-needling.
NEED TO KNOW!
It is very important to take skin type and sensitivity into account to decrease trauma or inflammation of the skin. This makes it essential to only consider these options under the care of your treating doctor. Trauma and inflammation can, unfortunately, lead to worsening of pigmentation problems, especially in patients with darker skin types.
Always sun protect, improve skin barrier quality, gradually integrate active ingredients with pigment-lifting properties into your skin care regime. And always be gentle with your skin.
Here’s wishing you happy skin days,