Managing Melasma

In this blog post you'll:

• Understand melasma and who is at risk
• Learn how tinted sunscreen is a secret weapon in managing melasma
• Combining treatments yields the most effective outcomes

Melasma is one of the more difficult skin conditions to treat. Treatment results can disappoint physicians and patients because melasma is not fully preventable and is likely to rebound. While melasma is not harmful, studies have shown it can lead to psychological problems and a poorer quality of life because of the changes in appearance melasma creates.

However, there are ways to manage melasma, and we will explore traditional and current treatment options here.

What is Melasma?

Melasma is a pigmentation disorder of the skin that mostly affects women, especially those with darker skin. It’s commonly seen on the cheeks, nose, chin, above the upper lip, and the forehead.

Melasma appears as brown patches or freckle-like spots that are darker than the normal skin tone. Many women first experience melasma during pregnancy or when they begin taking birth control pills. It’s so common during pregnancy it’s often referred to as the “mask of pregnancy.”

Melasma is caused by the overproduction of melanin by melanocytes, which various factors can trigger:

• Sun Exposure: UV radiation stimulates melanocytes, leading to excess melanin production.
• Hormonal Changes: Pregnancy, birth control pills, and hormone replacement therapy can trigger melasma due to hormonal fluctuations.
• Genetic Predisposition: A family history of melasma increases the likelihood of developing the condition.
• Medications and Cosmetics: Certain medications that make the skin more sensitive to sunlight and cosmetic products that cause skin irritation can exacerbate melasma.

Visible Light has also been shown to trigger melasma.

An article published by Harvard Health Publishing presents data from recent studies showing that visible light can also trigger melasma. Visible light can be perceived by the human eye but is not blocked by UVA and UVB sunscreens. The sun emits visible light, but it also includes artificial sources like medical devices, screens, and light bulbs.

While visible light has several therapeutic uses at specific wavelengths, including treating superficial blood vessels, removing unwanted hair, and treating acne and precancerous lesions, it can also have negative effects on the skin.

Visible light penetrates much deeper into the skin than UV radiation. It has been shown to exacerbate excess skin pigmentation, including melasma and post-inflammatory hyperpigmentation.
One study showed that visible light caused more noticeable, persistent hyperpigmentation than UVA alone, especially in people with dark skin tones. Blue light from screens seems to promote pigment production more than other wavelengths of visible light.

Unfortunately, broad-spectrum sunscreen does not block visible light.

Broad-spectrum sunscreens contain filters that block UVA and UVB but are not designed to block visible light. The filters in these sunscreens are made with smaller nanoparticles to reduce the white appearance on the skin. The problem is that visible light is only blocked by something visible on the skin.

Here’s some good news. Tinted sunscreen helps block visible light.

Tinted sunscreens combine broad-spectrum mineral UV filters, like zinc oxide and titanium dioxide, with added pigments — pigmentary titanium dioxides and iron oxides — that create the visible, skin-tone color that can reflect away visible light. The colored base of tinted sunscreens is created by mixing different amounts of black, red, and yellow iron oxides with pigmentary titanium dioxide, resulting in a tinted sunscreen that can be matched to any skin tone.

While these pigments are considered inactive, two reports of allergic reactions to iron oxides contained in mascara products have been reported. Otherwise, these ingredients appear to be well tolerated.

Skin Therapeutic Tinted Moisturizer, SPF 30, is a broad-spectrum mineral-based sunscreen with a light tint that blends well with most skin tones. The shade of the tint is designed to even skin tone rather than add color. It’s also a moisturizer and doesn’t smell like a typical sunscreen, which makes it an exceptional daily-use product. Blocking visible light adds to its appeal since most people have high amounts of screen time each day.

The most common groups that develop melasma

Only 1% of the total population will experience melasma, but the number can be as high as 50% in high-risk groups. Why a trigger causes melasma in some people but not others isn’t entirely clear. We do know that some people have a higher risk of developing melasma. You have a greater risk if you:

• Are a woman between the ages of 20 and 40: Melasma is much more common in women than men. Hormones seem to play a role in causing melasma.
• Have a medium or dark skin tone: Melasma develops more frequently in these skin tones than in lighter skin tones. You’re more likely to develop melasma if you are a woman of Latin, Asian, Black, or Native American heritage.
• Have a blood relative who has melasma: Several studies have found that patients with melasma often have one or more blood relatives who also have melasma.

Treatment Options

There is no one-size-fits-all treatment for melasma. Each patient should be evaluated and thoroughly assessed to determine the best path for their skin. Most studies show that combining treatments yields the best results.

Combination treatments have better results because they address different aspects of melasma and where it resides in the skin.

• Cellular turnover. Increasing cellular turnover removes layers of the skin with visible melanin spots. Different treatments and products are needed for visible spots in the epidermis and melanin deeper in the dermis.

• Excess melanin production. Visible dark spots result from melanocytes being triggered and becoming more active. Active melanocytes produce more pigment, causing dark spots to appear on the skin. In-office treatments and skincare products with ingredients that target melanin can help reduce its production.

Here are some treatment options recommended by the American Academy of Dermatology.

• Chemical peel: During this procedure, your dermatologist applies a chemical solution to the melasma. This can help remove excess pigment. Delasco has the widest range of chemical peels available. You can find the peels right for your practice, from light to deep resurfacing peels. See the entire peel line here.
  
  
• Microdermabrasion: This mechanical exfoliation technique can improve melasma by removing the outer layer of skin.
• Microneedling: This minimally invasive procedure creates microscopic tears in your skin. As the skin heals, it tends to have a more even skin tone.
• Laser and light treatments: Some studies have found that adding a laser or light treatment can improve results for patients who are already applying medication to their skin and protecting their skin from the sun. Other studies have shown laser and light treatments can exacerbate melasma in some patients, so testing on the skin prior to a treatment may help determine if the treatment is right.
• Platelet-rich plasma: This procedure involves taking a small amount of your blood, placing the blood into a machine that separates the blood into layers, and then injecting the layer of blood known as plasma into the skin with melasma. This can help even your skin tone.

Reappearance or rebounding of melasma has been shown to occur with any of most treatments. Products with the ingredients below used in combination with the above treatments help reduce reoccurrence.

• Hydroquinone: This is a common treatment for melasma. It is applied to the skin and works to even out the skin tone. Hydroquinone is no longer available in products that you can buy without a prescription. Hydroquinone works best on fair skin tones and may create hyperpigmentation on darker skin tones. Make sure to test on part of the skin before applying in large areas. Skin Therapeutic manufactures three peels that contain 2% hydroquinone. These can be very effective when used in a management plan. View Skin Therapeutic peels here.
• Tretinoin and a mild corticosteroid: This combination contains a retinoid and an anti-inflammatory, which can even out skin tone.
• Triple combination cream: This cream contains three medications: tretinoin (a retinoid), a corticosteroid to reduce inflammation, and hydroquinone to even out skin tone.
• Other medications: Dermatologists may prescribe a medication that’s gentler on your skin, such as azelaic acid, kojic acid, or vitamin C.

The best way to view treatments for melasma is as a management regimen. In some cases, melasma will fade or even go away over time as hormones and environments change for a patient. Understanding the different treatments available, when to combine them, and which topical products to recommend will yield the most consistent results for your patients.

Sources

• https://www.aad.org/public/diseases/a-z/melasma-treatment
• https://www.health.harvard.edu/blog/melasma-what-are-the-best-treatments-202207112776
• Tinted sunscreens: Benefits beyond an attractive glow - Harvard Health
• Melasma: Treatment, Causes & Prevention (clevelandclinic.org)