I spent nearly an hour perusing the Allure Skin Forum for women with melasma and read over and over how so many women all of a sudden got this skin condition that seemed to come from nowhere and refused to go away. So today, we break down MELASMA.
Here is what we know: 1. Melasma comes in the form of dark irregular sized patches of skin that can appear on cheeks, the forehead, and the upper lip. 2. Two factors are associated with causing melasma- hormonal changes and various wavelengths in the light spectrum. Hormonal changes can be anything from going on birth control, to hormone therapy, to getting pregnant (melasma is sometimes referred to as pregnancy mask). These changes in combination with light ranging from visible light, to heat, to UVB/UVA light sets off a reaction of melanogenesis that almost creates a form of skin memory that once in place can make people susceptible to melasma potentially for forever. Physicians have not been able to specify what exact concentrations of light set off this reaction and the two factors are not necessarily time sensitive. Women who might have had a baby three years ago can move to Florida and all of a sudden develop melasma. Not fun!
There are two degrees of melasma, superficial or deep. Superficial melasma resides in the second layer of the skin called the epidermis and involves increased melanin production in the melanocytes. Deep melasma on the other hand occurs in the melanophages (a pathologically different kind of skin cell) in the top third layer of the skin called the dermis. For diagnostic purposes, your dermatologist can distinguish between the two using a Woods or UV light. While both are visible to the naked eye, only superficial melasma will ‘light’ up under the Woods light.
The bad news is that deep melasma is trickier to treat as topical solutions cannot readily reach to the deeper dermis layer. Laser therapy with the Fraxel Restore system can be a good solution as it creates micro-pixel wounds that penetrate to the dermis while leaving the surrounding tissue intact. By reaching down to the melanophages and effectively breaking them up, one can begin to eradicate the melanin ‘memory’ that makes melasma a reoccurring event. Typically 4 treatments are required spaced 1-4 months apart. It is important to note that while the Fraxel Restore is specifically effective, one cannot class all lasers together especially since melasma is a light induced phenomena. In other words, do not let just any laser near your face!
For superficial melasma there are more options. Tricholoracetic or TCA peels, performed in your physician’s office, are actually a blend of different acids and can be used to effectively treat melasma. Essentially the key to treating superficial melasma is to remove the first dead layer of skin (called the stratus corneum) so that the targeted treatment can actually reach the melanocytes. Prescription retinoic acids or glycolic acids can also be used for this purpose as a daily at-home solution. Kojic and azelaic acid as well as licorice root are effective melanin inhibiting agents. Hydroquinone used to be the mainstay for treating melasma and as a skin lightener in general. While it can still be found in products like the Obagi line, it is now on to the Canadian Cosmetics Hotlist as being prohibited over worries of being carcinogenic. Formulators are rushing to find the ‘next’ hydroquinone. In the meantime, we currently sell the PCA product called Phaze 13 (http://www.pcaskin.com/) but are in the midst of coming up with our own. We are working on a way to stabilize a traditional Ayurvedic ingredient called Emblica that looks to be really promising. I will keep you posted on how it goes!
Finally, I read on the Allure forum about using microdermabrasion to help melasma and I just wanted to let people know that this might not be the best way. Remember, people with melasma tend to already have very reactive skin when it comes to pigmentation so microderms may be too aggressive in this case. Also microderms only temporarily strip the stratus corneum and you need to repeatedly strip the skin while using your pigment treatment so that it can properly absorb.
Feel free to write in with any questions!
All the Beauty Best,
Sara A. Dudley.Labels: Melasma