Above: Photos of different types of pigmentation disorders. The right diagnosis by your doctor is the most fundamental part of treatment
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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.
Solar lentigines are induced by UV light exposure. They appear as sharply circumscribed, uniformly pigmented macules that are located predominantly on the sun-exposed areas such as the face, back of the hands, the shoulders, and the scalp. Lentigines are a result of hyperplasia of keratinocytes and melanocytes, with increased accumulation of melanin in the keratinocytes.
Postinflammatory pigmentation is temporary pigmentation that follows injury or inflammatory disorder of the skin, such as acne. It is mostly observed in darker skin types Fitzpatrick IV-VI. Postinflammatory pigmentation is also called acquired melanosis.
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 the other pigmentation disorders, 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 the 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.
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.
Depigmenting agents work 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 depigmenting agent, Vitamin A derivative and topical anti-inflammatory agent was the first combination topical therapy to obtain US FDA approval. Triple combination therapy found to be superior to depigmenting agent monotherapy.
The side effect of depigmenting agents 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.
S.Lite Whitening Supplement
Antioxidants and Glutathione
Oxidative stress as a result of excess prodcution of free radicals and reduced antioxidant activity is a major cause to skin imperfections such as pigmentation, sagginess, and dull skin tone.
Grape (Vitis Vinifera) and Superoxide Dismutase (SOD) function as the first line of defence in prevention of oxidant formation. They act by suppressing the formation of free radicals.
Vitamin C, E and Zinc form the second level of antioxidant protection, providing protective effects at the end of the oxidative cascade.
L-Cysteine is an important amino acid that is involved in glutathione synthesis. Glutathione is a very important biochemical that plays a role in reducing oxidative stress.
Silkpeel dermalinfusion (Diamond Glow)
Lumixyl is a novel synthetic oligopeptide that inhibits tyrosinase enzymes. It has been shown to be more efficacious than depigmenting agents 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.
pHformula Chemical peels
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.
The unique pHformula powerclay formula used in the M.E.L.A. resurfacing treatments is a powerful hyperpigmentation treatment designed to reduce the accumulation of epidermally located melanin. It effectively inhibits the enzymatic activity of tyrosinase, whilst stimulating epidermal differentiation and therefore accelerates epidermal cellular turnover causing the removal of already formed melanin pigment. Due to the innovative highly effective mode of action, significant visible results are obtained with minimal risk.
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.
Nucleofill Polynucleotide injection
PDRN is extracted from the sperm of trout contains deoxyribonucleotide polymers with specific molecular weight distribution. PDRN was initially described as a tissue-repair stimulating agent extracted from human placenta.
PDRN exhibits properties in wound healing in skin disorders and other diseases via PDRN-A2Apathway. PDRN also can trigger the salvage pathway for the synthesis of nucleic acid, nucleosides, and nucleotides. Together, these findings suggest that PDRN might play important roles in skin rejuvenation and energy saving metabolism.
This study has demonstrated that PDRN suppressed melanogenesis via the reduction of MITF and its downstream targets. These results reveal the underlying mechanism of action of PDRN and illustrate this as a new promising therapeutic approach for PIH in esthetic dermatology.
Nucleofill Strong contains 2.5% Polynucleotide gel, which is higher than the other Polynucleotide product available in Malaysia.