You may have a higher risk if you fit into these groups:
Women aged 20s to 40s: Estrogen and progesterone are thought to play a role in melasma
Medium or dark skin tones: Women of Asian, Latin, and African descent have a higher incidence of melasma
Have a blood relative with melasma: Several studies found a strong hereditary association with 48% of melasma patients reported having a blood relative with melasma in one study.
Diagnosis is often based on presentation. To get a close-up look, your doctor may use a specialized device that examines pigments in the layers of your skin for a definitive analysis. At VIDASKIN, we use a clinic-based VISIA skin analysis machine to accurately identify the type of pigment you suffer from, before recommending an appropriate course of treatment.
As different patients suffer from different root causes of melasma, there is no one-size-fits-all treatment for melasma. Additionally, since melasma is a long-term condition due to upregulation and sensitization of pigment-producing cells, treatment usually starts with reducing all risk factors for pigment production as much as possible. Sometimes melasma can stay around for years or decades, but many advancements have been made in recent years.
Sunlight causes melanocytes to produce more pigment, which can darken existing melasma and lead to new patches being formed. Your doctor will advise consistent use of a broad-spectrum sunscreen (SPF 50 or higher) throughout the day, minimising direct sun exposure and shading with hats or umbrellas.
For melasma, it is recommended to have sunscreen containing physical filters ie. zinc oxide, titanium dioxide or iron dioxide. An appropriate amount of sunscreen is necessary for effective coverage.
Hydroquinone (HQ) is the mainstay of melasma treatment. It is a prescription-only cream which disrupts melanocytic processes by destroying the membranous organelles of melanocytes1. When using hydroquinone, it is essential to ensure good sun protection and avoid sunlight, as this chemical may heighten sensitivity to solar rays.
Tretinoin and hydrocortisone combination creams contain a retinoid to drive turnover and discharge of melanin within the epidermis. Hydrocortisone is an anti-inflammatory which may reduce the irritation caused by tretinoin.
Triple combination (TC) creams contain all three ingredients – hydroquinone, tretinoin and hydrocortisone. Studies show that topical triple combination cream was far more effective than HQ cream alone.2
Topical Tranexamic acid inhibits melanin production through interfering with molecular processes within keratinocytes in the skin.3,4 Multiple studies in South Korea and China have verified its significant efficacy and good safety profile.5,6
Arbutin, azelaic acid, kojic acid and ascorbic acid are gentler on the skin, but still inhibit the production of melanin.
If topical creams do not significantly improve melasma, clinic treatments may be added to your treatment plan.
Chemical peels using tretinoin (retinoic), trichloroacetic acid (TCA) and amino fruit acid currently show significant results in studies, and outperform older generation chemicals such as glycolic acid (GA).
At VIDASKIN, our cocktail of retinoic acid, azelaic acid, kojic acid, ascorbic acid (Vitamin C), phytic acid and arbutin is a customisable, skin-brightening protocol performed by a medical doctor. Based on your skin type and condition, our doctor can determine the concentration of acids required in every session.
Laser treatments can also be used to target different types of melasma.
When used correctly, clinic treatments can speed up recovery; and in recalcitrant melasma that responds poorly to topicals, lasers and peels have a strong role to play.
Oral Tranexamic acid (TA) gives more significant results compared to topical creams, but rare side effects that may occur include gastrointestinal discomfort and hypomenorrhea (light periods). In one study, recurrence while taking oral TA was low (9.5% of cases). It is common and very well tolerated in patients, and your doctor would be happy to prescribe oral TA unless there are clear contraindications otherwise.