Melasma pigment problems in your skin and what to do about it.
Melasma is the term given to hormone-induced extra pigmentation in the skin which most commonly looks brownish or even a bit grey. Melasma usually becomes more noticeable in the summer and improves during the winter months.
What causes melasma?
While the exact cause is not known, it is thought to be because of pigment-producing cells in the skin (melanocytes) producing too much pigment (melanin). This can be as a result of hormonal fluctuations, so it’s quite common when taking the oral contraceptive pill (the ‘Pill’); it can also happen during pregnancy when it is called chloasma or pregnancy mask. This can affect up to 50% of pregnant women to one degree or another.
Rarely, other medical problems that affect hormones (such as thyroid problems) may cause melasma, as well as some other medications, such as anti-epileptics. If in doubt — ask your doctor.
Exposure to ultraviolet (UV) light from the sun and the use of sunbeds or phototherapy can trigger melasma or make it worse. Most of us are now aware of the huge risks involved in sunbed use — not just for pigmentation problems and skin cancer but also for premature ageing of the skin.
Can melasma be cured?
At the moment there is no cure as such for melasma, but there are several treatment options that can improve the appearance of it. If melasma occurs during pregnancy, it may go away a few months after delivery and treatment may not be necessary- though it may come back during another pregnancy or if taking the contraceptive pill. Hydroquinone and retinoid creams should be avoided in pregnancy as they could harm the foetus. Even if it is treated, melasma often returns after stopping the treatments.
Melasma treatments fall into several distinct categories but they can be used in conjunction with each other:
- Try to avoid known triggers, such as contraceptive pills and hormone therapy.
- Avoid the sun (especially from late Spring to early Autumn) and using High SPF sun-blocking creams. Remember to regularly re-apply if you are out in the sun! Skin affected by melasma gets darker more so than the surrounding skin when exposed to light, so sun-avoidance and sun-protection are essential no matter what else you do.
- Skin lightening creams such as Hydroquinone must be prescribed by doctors — don’t be tempted to buy something off the internet as there are lots of bogus and dangerous products out there. Retinoid creams, such as the ones usually used to treat acne, and some types of home acidic skin peels (such as azelaic acid and kojic acid) can help improve the appearance of melasma. These can also cause skin irritation so it is best to use them under expert advice. Steroid creams can also be useful and are often mixed with the above chemicals to help prevent skin irritation but you do need to be cautious with these as well as they can damage the skin themselves.
- Procedures such as chemical peels, microneedling and laser therapy can also be employed to help with melasma. Chemical peels can improve melasma by removing the outermost cells of the skin that contain the pigment and generally refreshing the appearance of the skin. They should be undertaken only by an experienced practitioner though as they could make the pigmentation worse, lighten the skin too much or even cause scarring.
Microneedling is a skin rejuvenation process where the skin is repeatedly punctured with tiny needles to stimulate new collagen production and to help creams penetrate deeper into the skin. While this doesn’t directly reduce pigment formation it does improve skin quality which can reduce the appearance of the melasma. Proper microneedling devices should be used by an experienced practitioner to avoid complications such as even more pigment, pain, swelling, infections and scarring.
Some types of laser also remove the outer layer of skin, whereas others target the pigment-producing cells (melanocytes). The success of laser therapy is variable, and there are risks associated with this treatment, similar to the other invasive treatments. This procedure should only be performed by a highly experienced laser operator with extensive experience of treating pigmented skin problems.
- Skin camouflage. Skin camouflage can be used to hide the pigmentation of melasma and there is now a huge choice of concealing make-up available. Skin camouflage can be matched to your skin colour and some brands even have built-in SPF now. Help from trained cosmetic practitioners at professional level beauty spas can be invaluable for this.
One key thing to remember with melasma is that treating it earlier is better as it is easier to tackle when it is new. There are lots of options out there now to help with this condition but always do your research and get expert advice.
More information can be found from the British Association of Dermatologists information sheet on melasma.
Dr James Dean
Skin Doctor and Director at Freyja Medical Clinic.
