Unmasking pigmentation – Melasma

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.