Pigmentation treatment in Malaysia. Is laser the only solution?
What is melasma?
Melasma is an acquired pigmentation disorder commonly affecting women. It is also commonly known as chloasma, which is the mask of pregnancy. The word melasma itself is derived from the Greek work Melas, which means black. Melasma also affects men, but to a much lesser extent.
Melasma is characterised by irregular brown to brown gray patches on face. Melasma is more common in darker skin types Fitzpatrick skin types III-VI.
There are three main clinical patterns: centrofacial (more than half of cases), malar and mandibular.
Also classified by depth of involvement, epidermal and dermal melasma. Epidermal melasma affects the more superficial layer of skin, whereas dermal melasma is deeper. Most cases are comprised of a mixed type, where both epidermal and dermal types exist together.
Other pigmentary disorders
Freckles are usually much smaller patches of pigmentation, which occur more commonly among fairer skin types as opposed to melasma which occurs more commonly among darker skin types. Freckles may occur from a very young age, whereas melasma occurs during a woman’s reproductive age due to the association with female hormones.
Acquired bilateral nevus of ota like macules (ABNOM) are blue-gray to gray brown patchy and spotty pigmentation appearing bilaterally on the cheeks. It may be difficult to differentiate from melasma, but ABNOMs are typically more clustered, discrete and bluish in colour as opposed to brown. The pathophysiology of ABNOM is unknown, but may be due to activation of ectopic dermal melanocytes. Unlike melasma, ABNOMs are located deep in the dermis layer and therefore do not respond well to topical treatment.
What causes Melasma?
Although the exact cause of melasma is unknown, we do know the associated risk factors. Melasma has the hallmarks of photoaging skin disorder, including solar elastosis, increased mast cells, altered basement membrane and increase in vascularity.
Well established risk factors include sun exposure. Melasma is especially common in Malaysia because we have the sun all year long. UV radiation induces reactive oxygen species. Patients with melasma are found to have higher markers of oxidative stress.
About half of the cases melasma have positive family history. If you have a family member with melasma, then you are likely to be affected as well. Avoiding other risk factors may significantly reduce your risk.
Hormones play a significant role, with increased prevalence in seen in pregnancy, oral contraceptive usage and other hormonal therapies. Estrogen plays a role through estrogen mediated melanocyte stimulation. If you have other risk factors for developing melasma, then it is recommended that you choose alternative forms of contraception.
What are my treatment options?
The treatment of melasma and pigmentations typically include a multimodality approach incorporating photoprotection, antioxidant, topical lightening agents, exfoliating and resurfacing agents as required.
Do note that some clinics and laser centres may be pushing you to sign up for their laser treatments only. This could very likely be financially motivated, as the laser treatments are usually more costly and possibly more profitable.
Here we list down all the treatments and products that have been scientifically proven to be beneficial for pigmentation. Combining these different treatments will not only give you optimal results, but it could also save you from parting with your hard earned money.
Role of broad spectrum sunscreen was found to be beneficial in melasma management. This should be obvious enough, as one of the main risk factors for developing melasma is UV radiation from sun exposure. Patients with melasma should be applying at least SPF30 daily to reduce pigmentation following sun exposure. Dr Bob Remedies Sunblock is rated at SPF46.
Hydroquinone works by inhibiting tyrosinase, which prevents conversion of DOPA to melanin. Pigment lightening usually can be seen in 5-7 weeks.
A triple combination therapy containing hydroquinone, topical retinoid and topical corticosteroid was the first combination topical therapy to obtain US FDA approval. Triple combination therapy found to be superior to hydroquinone monotherapy.
The side effects of hydroquinone include that it can cause irritant dermatitis in some individuals. Long term usage can lead to exogenous ochronosis. Due to these concerns, there is a need to find safer alternatives.
Arbutin is an extract from the Bearberry plant. It is one of the most efficient skin lighteners, reducing skin pigmentation by competitively inhibiting tyrosinase. Dr Bob Remedies contains Alpha Arbutin, which is the more stable and effective form of Arbutin.
Lumixyl is a novel synthetic oligopeptide that inhibits tyrosinase enzymes. It has been shown to be more efficacious than hydroquinone at similar concentrations without the cytotoxicity. It is non irritating to the skin, and can be safely used even in pregnancy. Lumixyl is found in Silkpeel Dermalinfusion Skin Brightening Pro Infusion Serum.
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Chemical peels have the capability to disrupt epidermal cell cohesion and subsequent regeneration. The peeling effect enables removal of epidermal melanin as well as melanin from keratinocytes. Chemical peels also halts melanosome transfer to keratinocytes.
Literature evidence has shown that clearance of melasma is better and faster when topical treatment is combined with chemical peels. Peels yield good results in epidermal melasma.
Treatment of pigmented skin lesions with picosecond laser technology has shown to be an effective and safe method for restoring natural skin tone and decreasing hyperpigmentation.
However, doing lasers alone may not be able to give you the results you are looking for if not combined with other complementary treatments and taking proper care of your skin. In fact, most of the clinical studies performed for laser treatments shows that it works best when combined with other treatments such as depigmenting agents.
*New! Injectable treatment for pigmentation from Hyalual
Dr Bob Clinic is proud to introduce the latest treatment for pigmentation with injectables in Malaysia: Hyalual Booster, Hyalual Smart and Hyalual Light. These products are also known as Xela Rederm outside of Malaysia.
The active ingredients in these injectables is a combination of Hyaluronic acid, which is also found in Skin Boosters, and Succinic Acid.
Succinic acid is a dicarboxylic acid with metal-chelating potential and particular affinity to copper. Copper has a vital role in the activity of the enzyme tyrosinase, and therefore the chelation of copper in tyrosinase will effectively block the enzyme activity, restricting the production of melanin and thus the development of pigmentation.
Succinic acid also happens to be a potent antioxidant. Antioxidants mechanism of action is through the inhibition of free oxygen radicals, and the oxidising action of the tyrosinase. The end result is a decrease in the intensity of the melanin colour from the oxidised state (black) and in the reduced state (brown).
Trust Dr Bob Clinic for your pigmentation concerns
At Dr Bob Clinic, we are experienced and knowledgeable to diagnose your skin condition and customise the most suitable treatment option for your skin. We have many years of experience treating various types of skin pigmentation concerns.
We only offer clinically proven, safe and effective treatments to ensure that you achieve the results you desire. We adopt a multimodal approach of combining these treatments to suit your condition.