What is Melasma?

Melasma is a common skin condition. Brown patches appear on the cheeks, nose and sometimes over the forehead and upper lip. Melasma is also know as Cholasma, the mask of pregnancy, as it is often more apparent after childbirth. Indeed, this pigmented skin condition is significantly more prevalent in women with up to 90% of the cases involving females, mostly occurring between the  20-40 years of age. 

What causes Melasma?

Melasma is due to the overproduction of melanin (skin pigment) that can be triggered off by a number of factors. While about 30% of individuals with melasma may report someone in the family with a similar condition, this is often not the case.

Known Tigger Factors:

  • Sun exposure
  • Hormonal treatments such as oral contraceptive pills
  • Pregnancy; may increase with the number of childbirths
  • Medications and Cosmetic Products (especially if they irritate the skin)
  • Medical conditions; Hypothyroidism (low levels of circulating thyroid hormones)
wood's lamp used to examine melasma

How is Melasma Diagnosed?

Melasma is diagnosed based on the history, distribution and clinical examination of your skin. 

A Wood’s lamp is used to examine the distribution and severity of the condition. This serves as a guide to determine how deep the melasma is, and the presence of other pigmented skin conditions, such as freckles and sun spots.

The Melasma Area and Severity Index (MASI) can be used to assess the severity and extent of your melasma. This measure of assessment takes into account the area involved, darkness and homogeneity of the areas. The higher the score, the more severe the symptoms. However this remains a subjective assessment tool, and serial clinical photography remains a practical way to assess response to treatment. 

Of course, while we have tools to assess the physical symptoms, we must not underestimate the psychological impact of the skin condition. Often in Asian cultures, individuals may feel self conscious, embarrassed and feel the condition to be ‘unsightly’. 

How can I reduce my Melasma?

Although Melasma is considered a chronic pigmentary skin condition, there are steps that you can take to reduce the worsening of your symptoms.

  1. Elimate trigger factors such as oral contraceptive pills (unless it is deemed necessary), sunbeds, sun tanning
  2. Sun protection: Melasma is very sun sensitive. Use a Sunblock of at least SPF 30-50 and PA+++ regularly
  3. Cosmetic Camouflage

You will be able to find more resources here.

Melasma Treatment

The first line treatment of Melasma involves using a triple combination of products, which contains Hydroquinone, Tretinoin and a steroid. Hydroquinone is a skin lightening agent that reduces melanin synthesis by inhibiting the enzyme involved in the process. The tretinoin (a retinoid, or Vitamin A based cream) enhances melanin elimination by increasing cell turnover and reducing melanocytic activity. The steroid cream, which is mild in potency aims to reduce the skin irritation caused by the former two products, and further reduces pigmentation. This triple combination regime is reported to improve Melasma symptoms in 60-80% of individuals treated, and visible improvement is noticeable at 8 weeks. At APAX Medical & Aesthetics Clinic, we specially compound our products that is customised to your skin type.

Other Topical formulations thought to be beneficial may include:

  • Azelaic acid
  • Kojic acid
  • Tranexamic acid
  • Cysteamine 
  • Ascorbic acid (Vitamin C)

Alternative melasma treatment options include chemical peels, dermabrasion and lasers. Low energy Q-Switched lasers for pigmentation removal have shown to be effective for melasma individuals, with less side effects and lesser downtime compared to ablative lasers such as CO2 laser. This method of melasma treatment is able to damage the pigment producing cells and cause dispersion of the melanin. 

Every individual is unique in the distribution and severity of the melasma. A customised and holistic approach will lead to better results in this challenging skin condition.