Melasma pigmentation treatment

Melasma is a form of facial pigmentation stimulated by UV radiation and oestrogen. It is a difficult form of pigmentation to treatment. It is addressed with laser, lightening creams, sunscreens, and tranexemic acid.

Quick Facts about Melasma Treatment

  • Melasma is a form of pigmentation stimulated by oestrogen and UV exposure.
  • It appears as brown-grey patches on the cheeks, upper lip, between the brows, and forehead.
  • Underlying causes of melasma, such as the oral contraceptive pill, need to be addressed firstly.
  • Sunscreens, lightening agents, PIQO4 laser treatmentmedlite laser treatments, Fraxel laser treatment, and chemical peels can be used to treat melasma.
  • Tranexemic acid, which is an oral medication can also be used to treat melasma.

What is melasma?

Melasma, also known as chloasma, is a form of pigmentation that is stimulated by oestrogen – either from pregnancy, the pill, hormone replacement therapy or normal circulating oestrogens,  and is a difficult form of pigmentation to treat. As a result, melasma mostly affects women, although it can occur uncommonly in men. It appears as large brown-grey patches on the face. It is usually located on the cheeks, upper lip, between the brows, or on the forehead. Most people who are affected by melasma tend to have a more olive or dark complexion. Melasma can never really be cured, but it can be treated to minimise its effect.

 

What causes melasma?

It is important to try to determine if there are any causative factors that may be exacerbating the pigmentation, for example, the oral contraceptive pill.

The next step is daily sun and UV protection and avoidance, and this is paramount in the treatment of melasma. UV radiation is a key factor that exacerbates melasma, and often those affected with melasma first notice it appear during or after a summer where they have had significant UV exposure. Using sunscreen on a daily basis, irrespective of the weather or your planned (or unplanned) exposure to the sun, is very important. Sun avoidance or obtaining shade wherever possible is also important.

A topical lightening agent such as  Kligman’s formula is often recommended for melasma, as it is a powerful combination of lightening and exfoliating agents to help lighten skin pigmentation. Kligman’s formula is prescribed by our doctors. It contains; hydroquinone, which helps to prevent the production of new melanin (skin pigment), tretinoin, which helps to exfoliate and flush out exisiting melanin, and hydrocortisone, which helps to calm the skin from these active ingredients.

 

The Medlite laser can help reduce melasma, through weekly to monthly treatments for 6 to 8 sessions. The Medlite laser wavelengths used are more highly attracted to melasma or areas of higher pigmentation than normal skin with less pigmentation. The Medlite laser also works by using very short nanosecond pulses (as short as a few billionths of a second) that help to shatter the melasma pigmentation.  The short pulses deliver minimal heat energy to the skin and therefore have more of a mechanical effect on the pigmentation rather than a heating effect on the pigmentation. This mechanical effect allows the breakdown of pigmentation without heating the skin and worsening of the pigmentation. The downtime is minimal (usually only mild redness for a day) per treatment. Generally, most people go back to work the day after treatment.
More recently, picosecond lasers (lasers that emit pulses that are as short as a few trillionths of a second) have been used to treat melasma. The Piqo4 laser is an example of a laser that is able to emit picosecond pulses. These ultrashort pulses have very little heat energy and are able to break down the melanin or pigment that causes melasma.

The Fraxel laser is another option for the treatment of melasma. It has FDA (Food and Drug Administration) approval for the treatment of melasma in the US. As the name suggests, the Fraxel laser only treats a fraction of the skin by firing micro-columns of laser energy into the skin. The fractional nature of the laser allows the melasma pigmentation to break down and extruded from the skin. Furthermore, it has two wavelengths that penetrate to different depths within the skin to target melasma at all levels.  Usually, 2-3 treatments are required, and there may be a few days recovery required post treatment.

Other lasers or IPL are often used in the treatment of melasma, however there tends to be more risk of hyperpigmentation in response to this treatment. This occurs when excessive heat/energy is transferred to the skin by the laser/IPL and this causes inflammation which leads to the formation of extra pigmentation.

Chemical peels can help speed the process of improvement from melasma by helping with skin turnover, and by helping to shift the melanin deposits from the affected area. Usually, light chemical peels are used, as stronger chemical peels can often stimulate new pigmentation production.

An oral medication, tranexemic acid, can also be used to treat melasma effectively. Traditionally it has been used to stop bleeding, such as heavy menstrual bleeding or bleeding post dental extraction, but in smaller dosages can be used to prevent the formation of melanin (pigmentation) in response to UV radiation.

As a note of caution, it is important to note that melasma is a chronic skin condition, and cannot be cured. The above treatments all help in the treatment of melasma, but it tends to have a strong tendency to return, so maintenance treatments are essential.

This patient presents with melasma over her cheeks, chin, and forehead. She also has some acne present. Normally, she wears sunscreen daily, and is careful to avoid excessive sun exposure. The ‘after’ photos are the result of one month’s treatment with Kligman’s formula. Note the improvement in the melasma/pigmentation in all areas. Also of note is the improvement in acne, which is most likely due to the retinoic acid present in Kligman’s formula. Retinoic acid can help to exfoliate the skin and improve acne.

  

 

  

 

  

 

This is a before and after picture of a female with melasma on her upper lip that was treated for 6 months with Kligman’s formula only.

skin pigmentation case study

This was a 40 year old female of Indian origin who presented with melasma affecting both cheeks. She was treated for 2 months with Kligman’s formula and weekly Medlite laser treatments at 1064nm. There was considerable improvement in the pigmentation, and she also experienced an improvement in the skin texture and smoothness as a result of the laser treatments.

skin pigmentation case study

skin pigmentation case study

This patient presents with melasma affecting the typical areas of the forehead, cheeks and around the mouth. She was put on our melasma program, and undertook 4 sessions of Medlite laser treatment, used a skin lightening serum, and oral tranexemic acid. The result shown was after a few months of the treatment.

melasma-ba

Melasma is a difficult condition to treat, and treated improperly, can often be made worse.  At Victorian Cosmetic Institute, we specialise in the treatment of pigmentation problems such as melasma, and we have access to a wide range of treatment modalities, including prescription lightening creams, lasers and chemical peels.

Making that first phone call about any cosmetic procedure can be a confronting task – many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.

Otherwise, you can phone us directly on 1300 863 824.
 

 

Dr. Gavin Chan
Dr. Gavin Chan

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