What are the clinical features of melasma?

“melasma”

The inherent nature of Melasma does make treatment a challenge since Melasma is a mixed dermal (deep) and epidermal (superficial) form of skin pigmentation. The pigmentation develops through these layers of the skin, effective treatment of Melasma has previously been difficult to achieve. While there are several other treatments available for reducing the discolouration of Melasma, therapeutic Laser treatment is increasingly being recommended as a safe and effective therapy for Melasma.

A substantial body of opinion has developed revealing that Q-switched lasers such as the MedLite laser as used by City Laser Clinic are especially effective because the machine can deliver 2 classes of therapeutic laser. The ability to deliver different laser forms, appropriate for the various types of lesion is especially necessary for treating Melasma because it presents as dermal (deep) and epidermal (superficial) pigmentation. The MedLite allows the operator to select:

  • A wavelength of 532nm suitable for treatment of near surface (epidermal) skin pigmentations, as well as;
  • A wavelength of 1064nm that is more suitable for treatment of pigmentations in the dermal (deep) layer of the skin.

Presents as macules (freckle-like spots) and larger flat brown patches.These are found on both sides of the face and have an irregular border. There are several distinct patterns:

  • Centrofacial pattern: forehead, cheeks, nose and upper lips
  • Malar pattern: cheeks and nose
  • Lateral cheek pattern
  • Mandibular pattern: jawline
  • Reddened or inflamed forms of melasma (also called erythrosis pigmentosa faciei)
  • Poikiloderma of Civatte: reddened, photoaging changes seen on the sides of the neck, mostly affecting patients older than 50 years
  • Brachial type of melasma affecting shoulders and upper arms (also called acquired brachial cutaneousdyschromatosis).

We are very aware that Melasma, a chronic blotchy brown facial pigmentation, can be embarrassing and distressing. Although Melasma treatments However, with our Medlite Q- Switched laser in combination with skin lightening agents, chemical peels, and some general measures we can substantially lighten the discolouration, and improve your appearance. Melasma has a strong tenancy to return, so regular treatments and care is important. Some cases of Melasma are difficult to treat.

Melasma, sometimes called Chloasma, is much more common in women, and generally starts between the ages of 20-40, generally occurring people with naturally brown or well tanned skin. The pigmentation is from an overproduction of melanin by melanocytes, and the the pigment is absorbed by keratinocytes in the epidermis, and/or the dermis. If a family member has been affected it is more than likely to occur in other family members.

The known triggers of Melasma include UV Radiation, Pregnancy, Various Hormonal Treatments, ( Eg., Pill or HRT) Hypothyroidism, and certain soaps, medications and deodorants can trigger a phototoxic reaction causing long term Melasma.


Our Treatments

 

Medlite Q-Switched Laser at regular intervals. This laser laser targets the extra melanin in the skin and shatters the pigment with incredibly fast pulses of light energy(1 billionth of a second) There is more of a mechanical effect to this, as against a heat affect, which is used by other lasers. The beauty of this, is that this is no significant down time after treatment.

A lightening agent ‘Kilgsman Formula’ a topical lotion will be given to you, and regular use of this lightens the skin over the areas where applied. This contains Hydroquinone 3%, which has been proven to decrease production of Melanin, Retin-A which stimulates the production of new healthy skin cells, and Hydrocortisone, which reduces any irritation and inflammation of the skin.

Chemical Peels, light in nature, will also be recommended, as these help to turn over the skin cells, and remove existing pigment.

Vitamin C Creams help to decrease the production of pigment as well as improve skin cell turnover.

General measures

  • Cease all forms of hormonal medications.
  • Year-round life-long sun protection with a high SPF factor 50+ is recommended.
  • Cleansers and light moisturisers.
  • Make up and Cosmetic Creams are invaluable disguising the pigment.

What are the clinical features of melasma?

Melasma presents as macules (freckle-like spots) and larger flat brown patches.These are found on both sides of the face and have an irregular border.

There are several distinct patterns:

  • Centrofacial pattern: forehead, cheeks, nose and upper lips
  • Malar pattern: cheeks and nose
  • Lateral cheek pattern
  • Mandibular pattern: jawline
  • Reddened or inflamed forms of melasma (also called erythrosis pigmentosa faciei)
  • Poikiloderma of Civatte: reddened, photoaging changes seen on the sides of the neck, mostly affecting patients older than 50 years
  • Brachial type of melasma affecting shoulders and upper arms (also called acquired brachial cutaneousdyschromatosis).

What causes melasma?

The cause of melasma is complex. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes (epidermal melanosis) and/or deposited in the dermis (dermalmelanosis, melanophages). There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people melasma is a chronic disorder.

Known triggers for melasma include:

  • Sun exposure and sun damage—this is the most important avoidable risk factor
  • Pregnancy—in affected women, the pigment often fades a few months after delivery
  • Hormone treatments—oral contraceptive pills containing oestrogen and/or progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women
  • Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries and cosmetics—these may cause a phototoxic reaction that triggers melasma, which may then persist long term
  • Hypothyroidism (low levels of circulating thyroid hormone)

Melasma commonly arises in healthy, non-pregnant adults. Lifelong sun exposure causes deposition of pigment within the dermis and this often persists longterm. Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes to produce more melanin.

Research is attempting to pinpoint the roles of stem cell, neural, vascular and local hormonal factors in promoting melanocyte activation.

What are the clinical features of melasma?

Melasma presents as macules (freckle-like spots) and larger flat brown patches.These are found on both sides of the face and have an irregular border. There are several distinct patterns.

  • Centrofacial pattern: forehead, cheeks, nose and upper lips
  • Malar pattern: cheeks and nose
  • Lateral cheek pattern
  • Mandibular pattern: jawline
  • Reddened or inflamed forms of melasma (also called erythrosis pigmentosa faciei)
  • Poikiloderma of Civatte: reddened, photoaging changes seen on the sides of the neck, mostly affecting patients older than 50 years
  • Brachial type of melasma affecting shoulders and upper arms (also called acquired brachial cutaneousdyschromatosis).

Melasma is sometimes separated into epidermal (skin surface), dermal (deeper) and mixed types. A Wood lamp that emits black light (UVA1) may be used to identify the depth of the pigment.

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Main Street Cosmetic & Skin clinic