Defying the Dark: Navigating The Challenges of Melasma Treatment

Melasma, also known as chloasma or the ‘mask of pregnancy’, is a very common condition usually seen in women of childbearing age. It is a chronic, and recurring disorder, which can be frustrating to both patients and physicians due to the challenging nature of treatment and the universal occurrence of relapses. Surprisingly, melasma can also affect men, although the prevalence varies across studies.

Melasma is caused by hyperfunctional melanocytes, increased melanin synthesis in the epidermis, and increased melanophages in the dermis. It typically manifests as irregular, light-brown to gray-brown macules and patches on sun-exposed skin. Melasma can be categorized into three types: epidermal, dermal, and mixed. In facial melasma, there are three typical patterns of distribution.

1. Centrofacial pattern (most common)

• Involves the forehead, cheeks, nose, upper lip and chin areas

2. Malar pattern

• Involves the lateral cheek area

3. Mandibular pattern (least common)

• Involves the lower jawline

What Triggers Melasma?

1. Genetic Predisposition:

• Melasma shows strong familial occurrence, especially in first-degree relatives.

2. Ultraviolet radiation:

• UV rays trigger a spectrum of events in the skin, including the melanin synthesis pathway. They induce skin erythema, angiogenesis (the formation of new blood vessels), cause oxidative stress, and impair skin barrier function. All of these events contribute to the development of melasma.

3. Hormonal Changes:

• Melasma often emerges in women who are pregnant or taking oral contraceptive pills due to increased estrogen levels.
  

• Maternal age at the pregnancy increased the risk by 8 % for each year older at primigravida.

4. Medications:

• Some medications for example anticonvulsants (phenytoin and hydantoin) is known to be contributing factor in both men and women.
  

5. Thyroid Disorder

• Thyroid disorders are frequent among melasma cases. Mandibular and malar distribution of melasma are frequent. Hypothyroidism was the most common thyroid disorder with fewer hyperthyroid cases.

How To Manage Melasma?

The management of melasma is often challenging, often marked by incomplete responses and frequent relapses. However, there is an array of therapeutic options available, such as photoprotection, skin lighteners, exfoliants, antioxidants, resurfacing procedures, light therapy, and laser treatments, which can effectively prevent the condition from worsening.

Strict adherence to photoprotection measures, including sun avoidance, wearing sun-protective clothing, and using broad-spectrum sunscreens (preferably mineral sunscreen with SPF 50 or higher, containing iron oxide), is of paramount importance in the quest to combat melasma. You are encouraged to follow these practices diligently.

At Dream Clinic, we offer you these medical aesthetic treatments tailored to your specific needs and requirements.

• Microdermabrasion (MDA)

- The MDA step is crucial in medical-grade facials like LumiGrade and Neutroface. It helps exfoliate the outermost layer of skin (dead cells) and provides you with an instant 'skin glow.

• Topical skin-lightening agents

- FDA-approved Triple Combination Cream (hydroquinone + tretinoin + fluocinolone)

- Hydroquinone cream and Cyspera series to help in depigmentation.

• Oral Tranexamic Acid (TXA)

- Numerous studies have demonstrated the efficacy of oral TXA in melasma treatment without major side effects. It exhibits hemostatic (skin stabilizing effect), anti-inflammatory, and anti-allergic effects through its anti-plasmin activity.

• Superficial chemical peels

- Alpha Hydroxy Acid (AHA) for example glycolic acid and lactic acid or Beta Hydroxy Acid (BHA) are used in conjunction with topical treatment for a better response. They help increase epidermal turnover.

When it comes to treating melasma, laser therapy is not the first line of treatment. However, there are certain situations where incorporating laser therapy into the treatment strategy is beneficial.

1. Recalcitrant melasma:

- When the melasma shows poor response to topical creams and oral medication after 6-8 weeks.

2. Combination of pigmentary lesions:

- Lasers can improve other pigmentations such as freckles, sunspots, and Hori's Naevus while simultaneously treating melasma.

3. Patients seeking faster clearance:

- This is particularly common among patients preparing for upcoming events, although it's not always the ideal approach.

At Dream Clinic, the combination of laser therapy offered by our innovative laser systems, the Fotona StarWalker PQX and Fotona SP Dynamis NX Line, is always an excellent strategy.

The Fotona StarWalker PQX laser utilizes Picosecond laser technology, making it the ideal tool for efficient skin pigment removal without causing damage to surrounding tissues or resulting in unwanted side effects. Picosecond laser pulses specifically target pigments without affecting skin cells, ensuring precise and safe treatment. Additionally, the Fotona SP Dynamis NX Line targets the vascular factor because blood vessels also play a role in the development of melasma.

Nutshells

In conclusion, at Dream Clinic, we understand the impact melasma can have on one's confidence and self-esteem. With a team of experienced professionals, our approach emphasizes not only advanced laser therapies but also a deep understanding of each patient's unique skin needs. We believe in the power of personalized treatment plans, ensuring that every individual receives the care they deserve. Schedule a consultation today, and let us guide you on the journey to renewed confidence and radiant skin.