Melasma (Skin pigmentation)

With summer coming to an end, many patients are looking to us for some guidance of how to treat skin pigmentation.

The first step for us is to identify what is causing the pigmentation and what level of the epidermis the pigment is lying. It is also important to set expectations about reducing pigmentation - regardless of how well it is treated, it will always come back without ongoing management.

Today I will address a common abnormal pigmentation condition, Melasma, which causes patches of blotchy pigmentation, usually in a bilateral (both sides) distribution.

The condition affects more women than men, and tends to occur between the ages of 20 and 40 years. It is more common in patients with more olive skin tones.

Causes:

These are multifactorial and a bit complex. It is likely to be a combination of things - genetics, long term sun exposure, hormonal (it is more common in pregnancy and in those on the pill) and some medications.

The pigment producing cells in the epidermis (melanocytes), make more melanin and this is either transferred to the very superficial layers of the skin, or can be taken down deeper, into the dermis. It is important to realise this when treating, as treatments that just target the outer layers of the skin will not solve the problem of dermal involvement.

So how do we treat it:

1. Lifelong sun protection and reduced sun exposure. This means ALWAYS wearing sunscreen and reapplying it. Wearing hats and avoiding going out in the middle of the day is also important.

2. Products that reduce melanin production.

These are called ‘tyrosinase inhibitors’ as they block the enzyme that converts pre melanin (no colour) to melanin (which is brown). Inhibitors can be applied regularly in a skn care routine, and can also be applied during a clinic treatment aiming to push the product down deeper into the skin and increase the time concentrated inhibitors sit on the skin (an example is a Mela Peel or Dermalan Peel)

Common inhibitors we prescribe:

  • Retinoids (prescription vitamin A_

  • Kojic acid

  • Tranexamic acid

  • Ascorbic acid (vitamin C in powder form)

  • Hydroquinone

3. Exfoliants

These are used in combination with the tyrosinase inhibitors to help lift off the surface layers of the skin so the products can penetrate deeper.

4. Skin needling

The use of a TGA registered device, such as a SkinPen can be used to help ‘break up’ the pigmentation, augmenting the effect of the topical treatments. It may also have more of an impact on melanin that is sitting in the deeper layer of the skin (the dermis)

What about lasers?

Laser should be used with great caution in patients with melasma as it can often make it worse and it is not particularly effective in the first place. Care should always be taken to get medical advice before treating any skin pigmentation.

Want to know more?

The best place to start is by booking a consultation with myself or my cosmetic RN, Tracey Willis. We can go through the options available of set you on the right track. Call us on (02) 5925 5333 to book, email hello@cwmedical.com.au or book online now.

Cristy Houghton