Chroma Dermatology in Melbourne, specialise in diagnosing and treating pigmentation and treating patients with skin of colour. So, we usually see more than 15 patients per day with some kind of pigment concern. This ranges from white spots and freckles to discolouration and uneven skin tone. There are more than 45 causes of pigment on the face and many can look very similar to an untrained eye.

If you google “what are the causes of pigmentation on the face?” you will be flooded with (often scientifically incorrect) information about pigmentation. What is worse is that if you google “how to treat pigment,” or “best treatment for skin pigmentation” there will be a flood of sites written by non-qualified journalists or beauty editors dishing out advice on pigment and trying to sell the next expensive lotion or potion that is likely to do nothing more than put a dent in your wallet.

The first step is to get the right diagnosis.

The first important point is that “pigmentation” is not a diagnosis. Different causes of pigmentation require different treatment approaches. SPF is a measure of a sunscreen’s ability to prevent ultra-violet light (UV) B from damaging the skin.

Melasma is one of the most common causes of facial pigmentation

Melasma used to be called ‘chloasma’ or ‘mask of pregnancy’ but melasma can occur in males and females (so hormones alone aren’t the culprit) and is caused by a complex interplay between genetics, skin colour and type and exposure to ultra-violet light and visible light. The latest research emerging in the subcontinent (India) shows that heat may also play a role. 

SunSmart app
Here are the answers to some common questions we get asked by patients and dermatologists about melasma:
  • Can you cure melasma? Anyone that says that can cure melasma either doesn’t truly understand the condition or is kidding themselves. Melasma is a chronic and recurrent condition. But it is possible to significantly lighten most people’s melasma and manage flares when they occur. It’s about tailoring the treatment to the individual’s skin type, type of melasma and lifestyle.
  • How can melasma be prevented or how can I stop it from getting worse?
    • Ultra-violet light protection: Protecting your skin from ultra-violet light and possibly visible light (if you have darker skin) is the first important step. Staying in the shade and wearing a hat is important but sunscreen is also critical.
    • The type of sunscreen you need will be determined by your skin type, skin colour and your lifestyle. For example, people with sensitive skin who run, cycle or swim will need different sunscreen formulas to those who are prone to acne and work in an office.
    • It is important to know that there are cosmetic sunscreens and therapeutic sunscreens. Cosmetic sunscreens often do not provide adequate protection against ultra-violet light B and A and are not regulated under the Therapeutic Goods Administration which is an organisation that regulates sunscreen advertising and standards.
    • Niacinamide! Niacinamide is a form of vitamin B3, which is an essential nutrient that supports the cells of the body in their daily functioning. Niacinamide is found primarily in animal-based products but for many years now, scientific research has demonstrated that it helps improve mild pigment (in concentrations over 4%), acne, rosacea and is a good anti-aging ingredient too. If you look online or in stores, nearly everything has niacinamide built into it. But don’t be fooled, a higher price doesn’t mean the product is better. Concentrations of less than 4% are unlikely to help with pigment and products marked ‘organic’ can actually contain botanicals (plant and seed extracts and fragrance) that can actually make pigment worse. While we can’t point out brands on this blog, we can say that there are a few brands that dermatologists will recommend over others.
  • Is hydroquinone cream dangerous?
    Hydroquinone (HQ) is an ingredient that is found in the over-the-counter product called “Superfade” here in Australia. Concentrations of 2% of more of HQ require a prescription. It is currently the gold-standard cream for treating pigmentation on the skin that is located in the epidermis (top layer of the skin). It can be combined with other ingredients like vitamin-A derived creams for enhanced effect. There is no scientific research whatsoever to demonstrate that HQ causes any internal problems or cancers. In fact, traces of HQ are actually found in certain foods and drinks we consume regularly like pears, beans, broccoli and tea and coffee! The claims that this is an ‘unsafe’ ingredient are not true. What is true is that this ingredient, in very rare cases, may cause a darkening of the pigmentation. This is more common if HQ-containing creams are purchased from unknown online sources or overseas where strict pharmacy laws for compounding (physically making) creams are not in place.
  • I have been told laser treatment will fix my melasma – is that true?
    We need to stress here that we are discussing melasma, not freckles. Laser works really well for dark freckles. Melasma is a different story.
melanoma-chromaderm
Middle-aged Indian woman with melasma on her face

In really severe cases of melasma where prescribed creams, combination creams, chemical peels and tablets have not been helpful, laser could be tried but extreme caution is needed. In some cases of melasma, lasers can make pigment from melasma irreversibly worse!

And remember, lasers are like cars, not all lasers are created equal and getting the right diagnosis and an experienced laser operator are important to get a successful outcome. At Chroma Dermatology, for selected, severe cases of melasma, we use our PicoSureTM laser to assist with decreasing melasma over time. 

If you are considering laser treatment for your melasma, I would strongly suggest you seek an opinion from a dermatologist with expertise in pigment problems first. As they say, better safe than sorry. 

 

 Take home messages:
1. Get the right diagnosis: Many patients are diagnosed with “pigment” and then treated with either minimal or no improvements. Start right by getting the right diagnosis and right treatment for you.
2. Learn more about melasma. What it looks like, why it occurs and more detail about treatment options 
 
The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information.

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