Melasma is a common skin condition that causes tan to gray-brown patches on the face and develops mainly in women. At Castleknock Cosmetic Clinic Dublin we see melasma affecting people of all ethnic groups, but particularly those with Fitzpatrick skin types IV–VI (See the Skin Typing Chart). It is also known as chloasma or mask of pregnancy.
Melasma usually forms on the cheeks, bridge of the nose, forehead, chin, and upper lip, and occasionally on the forearms and neck. It may develop during pregnancy, while taking birth control pills or during menopause. Sometimes it appears for no obvious reason.
Who gets melasma?
Most melasma occurs in women in their reproductive years. Only 10 percent of those affected are men. It generally starts between the age of 30 and 40.
It is more common in people that tan well or have naturally dark skin compared with those who have fair skin, particularly if they live in a sunny area. It is often seen in Asia, the Middle East, South America, Africa and the Indian subcontinent.
Appearance of Melasma
Tan or brown spots are seen mainly on the cheeks, jaw, forehead, nose, chin, and above the upper lip.
Melasma is sometimes separated into epidermal (skin surface), dermal (deeper) and mixed types. The dermal and mixed types are significantly more difficult to treat than the superficial form of melisma. The type of melasma can be diagnosed clinically with the help of a Wood’s Lamp or a skin biopsy may be necessary to determine the depth of the disorder.
Type of melasma
• Well-defined border
• Dark brown color
• Appears more obvious under Wood’s Lamp
• Responds well to treatment
• Ill-defined border
• Light brown or brown-gray color
• Unchanged under Wood’s Lamp
• Responds poorly to treatment
• Combination of light and brown patches
• Partial improvement with treatment
Causes of Melasma
What causes melasma is still unknown. People with a family history of melasma are more likely to develop this skin condition. The two most common triggers for melasma are sun exposure and an increase in female hormones estrogen and progesterone, such as during pregnancy or while taking birth control pills or hormone replacement therapy. Other triggers include cosmetics, phototoxic drugs (make the skin more susceptible to light damage), anti-seizure medications.
Treatments for Melasma
Sometimes melasma fades on its own. This is especially true after a pregnancy or when a woman stops taking birth control pills. If the melasma does not gradually fade or a woman wants to continue taking birth control pills, melasma can be treated.
Treating melasma often requires a comprehensive approach
Avoiding the sun and using a high factor SPF 50+ broad-spectrum sunscreen is key to preventing melasma. This is essential because even when it is cloudy outside, the sun’s UV rays can penetrate the skin. Sunscreen also must be worn when most of the day will be spent indoors because even a brief walk, driving, or sitting next to a window can expose unprotected skin to enough sunlight to trigger melasma. Continuing to wear sunscreen every day after the melasma clears can prevent it from returning.
Without the strict avoidance of sunlight, successful treatments for melasma are doomed to failure.
Topical medications containing hydroquinone help fade melasma. Prescription fading creams contain 4% hydroquinone, sometimes in combination with sunscreen, retinoids and glycolic acid.
Creams containing tretinoin, kojic acid, and azelaic acid, singularly or in combination, have been shown to improve the appearance of melasma.
Chemical peels containing melasma suppressant medication are effective in treating the condition. Furthermore they add favourably to silky smooth skin texture. Chemical peels work well with Superficial Melasma.
Fractioinal CO2 Skin Resurfacing
Fractional CO2 Laser Skin Resurfacing work well for superficial and Deep melasma. The CO2 Laser is considered to be the gold standard in hyperpigmentation treatment. A downtime of about a week is associated with the treatment.
Broad band laser and IPL treatments are gentle effective way of controlling melasma, without the downtime associated with recovery. It’s most effective for Superficial Melasma.
At Castleknock Cosmetic Clinic we careful tailor the treatments to the patient’s skin type, which both improves the outcome and helps avoid complications. Similar therapies are used clinically to treat post inflammatory hyperpigmentation. For all therapies sunscreen use and UV avoidance is important.
Treatment cost depends on the level of intervention needed. To assess your individual needs, thorough skin analysis is performed utilizing ultraviolet imagery. The result of the skin analysis will guide us as to the best option of treatment.
Topical Medication €170
Chemical Peels €450
Fractrional CO2 Laser Resurfacing €1250
Broad Band Laser €250