The Mask of Pregnancy: Melasma is a facial pigmentation that mainly affects women
It can look quite obvious and may even be bad enough to affect a woman’s confidence. There have been many treatments touted to be able to cure Melasma. We look at what works and what does not.
First of all, what causes Melasma?
- Sun exposure is one big factor. That is why in any treatment for Melasma, sun protection is always an important factor.
- Genetics is another important factor but unfortunately, there is really nothing much you can do about this. If your mother has bad Melasma, there is a good chance you will have it too.
- Hormones are one of the key factors in the development of Melasma. In fact, up to 50% to 70% of women will develop it during pregnancy due to the hormonal changes. Taking contraceptive pills and hormone replacement treatment have also been linked to Melasma.
Rarely, thyroid medicines and anti-epilepsy medicines can cause Melasma.
Who gets it?
Most women I’m afraid, although there are men who also suffer from Melasma. The ratio of women to men is 20:1.
Women mostly get Melasma in their 40’s.
Where does it appear?
Most of the time right in the middle of the face. It can also appear on the cheekbones, upper lip and rarely along the jawline.
Most of the time, it is rather superficial. You can tell when the pigments have clearer borders and are light brown in colour.
Less frequently, it is deeper. These pigments have unclear borders are usually more grey than brown. These are much more difficult to treat.
What else can it be?
Melasma should be quite obvious if you know what you are looking for. Sometimes, it can be mistaken for Freckles, Sun Spots, Skin Allergies or a condition known as Hori’s Naevus.
So what are the treatments available?
Also Read: How NOT to treat Melasma
1. Sun Screen. This is oh-so-important. Women who use sunscreen regularly are up to 20 x less likely to develop Melasma! Whatever other treatment you are on, sunscreen is key to preventing Melasma from developing again. Use a broad spectrum protection sunscreen (UVA and UVB coverage) with SPF of at least 30. Remember to re-apply after lunch.
2. Hydroquinone-Retinoid-Steroid combination cream. This was developed by a dermatologist called Dr. Kligman and is still referred to today as Kilgman’s Formula by some. However, it is now marketed under many different brand names. I know what you are thinking ‘Steroids thin my skin!’ That might be true but when the steroid is combined with Retinoid, the Retinoid actually cancels out this side effect. There are also many ways these 3 chemicals interact and help each other to both treat Melasma as well as prevent each other’s complications! It is right now the easiest and safest treatment available for Melasma.
3. Tranexamic Acid. This is a medicine initially developed to treat heavy periods in women. However, it was found to be good at treating Melasma also. Dosage varies greatly from 500mg to 1500mg per day and treatment duration from 6 weeks to 6 months.
4. Chemical Peels. Put some acid on the face, the top layer of skin along with the pigments come off. How much simpler can it get? The problem with chemical peels is if you burn too deep, there is a risk of side effects. If you burn too shallow, the improvement of the Melasma may not be that dramatic.
5. IPL. Intense Pulse Light has been used to treat everything from Freckles to Melasma. The unfortunate thing about this treatment is in 30% of the time, it can actually make the Melasma worse.
6. Lasers. Many different lasers from Q-Switch to long pulse to fractionated to ablative have all been used to treat Melasma. Laser for pigmentation. Although each manufacturer has its own claim to fame, the fact remains none of these treatments can fully cure Melasma. As with all laser treatments, there is a risk of Post-Inflammatory Hyperpigmentation.
7. Patience. This is the safest treatment of all. Most Melasma will lighten over time but we are talking about years if not decades.
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