The most common amongst pigmentation disorders is melasma, an acquired brown to brownish-black pigmented spots seen on the face. Usually symmetrical and affecting over 40% of women in S.E. Asia, it is a chronic condition starting from early 30’s through menopause. Although harmless, some women are disturbed by melasma and seek medical treatments.
What Causes Melasma
Melasma is caused or aggravated by sun exposure, genes, age, hormones, drugs, oxidative stress, environmental stress (including pollution and heat), and vascular components.
Of these, the most damaging is the sun which radiates ultraviolet A and B, infra-red and visible blue lights; and these are major contribution of oxidative stress as well.
Recently oxidative stress and pollution are found to be the major cause and aggravation of melasma.
Oxidative stress also arises from a poor lifestyle such as smoking, excessive consumption of alcohol and late nights, a diet rich in refined sugar. Atmospheric pollutions add to the oxidative stresswithin the skin.
Treatment for Melasma
Treatment for melasma is challenging due to the multifactorial causes. Treatment includes topical creams, oral antioxidants, and clinical treatments. Of these, topical and oral medical treatments are the most effective in clearing melasma and preventing recurrence.
Sun protection is of utmost importance. Not all sunblock is equal in treating melasma. An effective sunblock should contain adequate UV filters for UVA light (i.e. PPD 15+ or PA++++), UVB light (i.e SPF >35), infra-red light (IR) as well as visible blue light (HEV).
A good blue light filter should have at least 35% barrier. Most commercially marketed sunblocks do not block off visible blue light.
A perfect sunblock protects against UV, Blue Light and including anti-pollution, anti-oxidant, non-comedogenic properties to provide protections beyond sun.
Anti-oxidants and anti-pollution ingredients are found in cosmetic creams and sunblock. By themselves they are not effective in clearing melasma and are used in conjunction with depigmenting creams.
Generally, those topical skin lighteners prescribed by doctors are backed by science or have been proven to work in clinical scientific trials. To be effective for melasma, they should contain multiple active ingredients that are safe and effective in targeting the multiple pathways of pigment formation.
An oral supplement containing natural crystal tomato carotenoids and cysteamine has shown in a clinical trial to be effective in controlling melasma with significant results.A series of chemical peels or light or laser procedures are often added to the medical treatments to improve melasma resistant to topical treatments.
Prevention of Recurrence
Melasma is a chronic skin problem. Steps must be taken to prevent recurrence which consists of daily sun protection, oral antioxidant as well as topical creams with skin lightening effects, anti-oxidants and anti-pollutants.
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This article was first published on Lianhe Zaobao and the English version published on our website with permission. Find the original article here.
(The author is a consultant dermatologist at Paragon Medical Center)
