PIGMENTATION​

MELASMA

At Chroma Dermatology, we specialise in pigment problems like melasma which is more common in those with skin of colour.

Pigmentation Services

The founder of Chroma Dermatology, Dr. Michelle Rodrigues, is a globally-reconigsed expert and key opinion leader in the diagnosis and management of melasma.

She has published numerous research papers and textbook chapters on the subject and has been invited to speak nationally and internationally on her unique diagnostic approaches and treatment regimens. This expertise, combined with her treatment methods gives patients the best possible chance of lightening pigment safely and effectively.

Pigment (light or dark brown or even black spots) on the face is one of the most common reasons that those with skin of colour will seek the advice of a dermatologist.

Melasma (also known as hormonal pigmentation or ‘mask of pregnancy’) is seen in women and men and is usually first noted between the ages of 30-50’s.

While those with skin of colour are more likely to develop melasma, those with lighter skin types may also be affected. The condition may cause anxiety, embarrassment and even depression.

It is important to be aware that not all pigmentation is melasma. Freckles, moles, age spots and other medical conditions common in darker skin types like post-inflammatory hyperpigmentation and lichen planus pigmentosus, are commonly mistaken for melasma by those that don’t have expertise in this area of dermatology.

While there are many magic lotions, potions and lasers that claim to be miracle treatments for melasma, some of these are dangerous and can cause the condition to become darker and more noticeable.

Consult Chroma Dermatology if you are interested in having your pigmentation carefully assessed, accurately diagnosed and treated with the latest, safe and scientifically-proven treatments.

Melasma is one of the most common causes of skin pigmentation worldwide.

Melasma is also known as chloasma and pigmentation of pregnancy. It is one of the most common causes of facial pigmentation. It appears as patchy brown-tan-black discolouration on the face and very rarely on the forearms. The excessive pigment (melanin) is in either the outermost layer of the skin (epidermis) or second layer of the skin (dermis) or both (epidermis and dermis).

Melasma usually occurs on the face – mainly on the cheeks, forehead and upper lip but can also be seen on the temples and nose. Rarely, it is also seen on the forearms.

 

Melasma is more common in females compared with males. It can occur in all skin types but is more common in those with skin of colour. Scientific literature shows that Melasma is the most common reason those with Indian skin see a dermatologist. In the western world, it usually appears for the first time when people reach their 30’s or 40’s.

 

While melasma doesn’t cause problems with internal organs, many experience anxiety, low self-esteem, depression and social isolation. 

 

Not every brown spot or mark on the face is melasma. Many patients are diagnosed with melasma when they actually have something entirely different. Freckles, Hori’s neavus, acanthosis nigricans and post-inflammatory pigmentation are just some of the many conditions that can look similar to melasma.

Melasma is a clinical diagnosis, which means the dermatologist will usually be able to diagnose it without the need for a skin biopsy. There are situations however, where a skin biopsy needs to be taken to exclude other causes of pigmentation. A wood’s may be needed to determine where the pigmentation is sitting (first layer of the skin (epidermis) or second layer (dermis) or both layers).

Ensuring you have the right diagnosis matters because different conditions require totally different treatment. Some types of pigmentation are due to underlying medical conditions and others will get worse if treated with creams and peels.

Sunscreen is the key to stop melasma worsening over time. Broad-spectrum sunscreen (SPF 50+ or more with high UVA protection) is best. If you have skin of colour, sunscreen with a built-in tint is a good idea. Sunscreen should be applied 20 minutes prior to sun exposure and re-applied every few hours (as per the instructions). A broad brimmed hat and seeking shade is important too.

Hydroquinone cream or lotion (2-8% either in a stand-alone formulation or mixed with other active ingredients) is the most widely used cream to treat melasma.  The higher the concentration of hydroquinone, the higher the incidence of irritant dermatitis (eczema). Hydroquinone should only be used for limited periods under the supervision of a dermatologist. Contrary to what is listed on some websites and blogs, there is absolutely no evidence to suggest hydroquinone cream causes cancer in humans.

Niacinamide is an anti-oxidant that has been scientifically proven to help pigmentation but you should speak to your dermatologist about which brands are best for you. The right concentration and formula are the key to success.

Other creams like Vitamin A creams, Ascorbic acid (vitamin C), Azelaic acid (20%) and combination creams can also be used depending on the type of melasma you have.

Chemical peels are best used with topical creams to enhance their effects. They also have the added bonus of improving texture and skin barrier function. Superficial chemical peels like glycolic and salicylic acid and retinoid peels are usually used. Pigment-specific combination peels can also be used to optimise results.

It is critical that the right type of peel and treatment plan is chosen for your skin type and type of melasma because everyone is different. Have a chat with your dermatologist to find out which one is best for you.

Laser can make melasma worse in some cases. Laser should therefore only be done for treatment resistant cases and should be done by a dermatologist with an in depth understanding of melasma and after a detailed discussion about the appropriateness of laser therapy.

Because the risk of complications, a small test treatment is usually recommended initially to ensure that the pigment does not react by becoming darker. Multiple treatments are necessary to see improvements and maintenance treatment will be needed. Only certain lasers should be used with extreme care, with special settings and under the guidance of a dermatologist.

Picosecond laser (755nm) is without doubt, the safest laser for those with melasma when used at specially selected low settings. Q-Switched Nd YAG laser (1064nm) at low power settings could also be used but problems can occur when patients get to about treatment number 10.

While other lasers like vascular laser (for erythrotelengiectatic subtype of melasma), and ablative fractional laser are potentially helpful for lighter skin, it should be avoided in darker skin types. Intense pulsed light (IPL) and fully ablative lasers should be avoided in melasma in any skin type.

Chroma Dermatology dermatologists have extensive experience and expertise with the use of oral tranexamic acid for melasma having used this since mid 2013. But most dermatologists using this treatment have only been doing so for a few years now, so it can still be considered ‘new’.

Tranexamic acid is most commonly used in a tablet form by selected dermatologists for melasma that has not responded to creams, peels and combination treatments. It is already available under the Pharmaceutical Benefits Scheme for excessive menstrual bleeding in Australia.

Not everyone can safely take this tablet. Those who are pregnant, breastfeeding, have had blood clots or strokes for example, cannot take this medication. It is best to discuss the details of this treatment with a dermatologist who uses it regularly to see if you are suitable for this treatment.

There is a new lightening cream that may be helpful for mild melasma called cysteamine. To date, this cream has only been studied by the company making the cream so there is no ‘unbiased’ research on this cream for melasma yet. This cream will be trialed at Chroma Dermatology at the start of 2019 and we look forward to publishing our results.

To learn more about pigmentation and melasma visit our blog.

If you have pigment and would like to have it assessed and potentially treated by pigment disorder experts book an appointment with a dermatologist at Chroma Dermatology today.

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