Melasma – A Chronic Condition
One of the biggest skin challenges we encounter on a daily
basis is melasma. Melasma appears to be most prevalent with darker skinned
women, primarily Asians and Hispanics.
I have seen a few Fitzpatrick II-III patients that present
with it as well. Melasma usually presents somewhat in a symmetrical pattern
involving one or a few areas such as the forehead, cheeks, jawline, upper lip
The pigment can involve the epidermis, dermis or a
combination. Most women report a seasonal pattern with complaints of pigment
worsening at the end of the summer.
We have learned to keep our patients' expectations low as
far as treatment results and counsel them that maintenance treatment may be
required. We recommend sun protection on a daily basis, even on a rainy, cloudy
day. Prescription and nonprescription topical creams may include one or more of
Various Botanical Ingredients
Various modalities can be used to treat the symptoms. In our
clinic, we use a combination of laser or light type devices, such as IPL and
laser toning, microdermabrasion and chemical peels. Micro-needling and conservative
fractional CO2 laser resurfacing alone, or enhanced with Platelet Rich Plasma
(PRP), also known as the "Vampire Facelift", aid in treatment.
PRP utilizes the patient's own repair-response to be
activated. Their plasma, rich in growth factors, is applied after micro-channels
are created in the skin to stimulate the stem cells to repair. Great caution is
taken with these patients, because melanocytes can be over-stimulated. When too
much inflammation is created, symptoms can worsen.
Fraxel was one of the first laser type technologies that had
FDA approval to treat Melasma. Unfortunately some patients developed more
hyperpigmentation post procedure.
I like explaining to patients that the development of
melasma is not fully understood. Genetic factors can play a role in the
formation of melasma and can be affected by hormone fluctuations and
Estrogen receptors on melanocytes have been found to
stimulate the production of more melanin in some studies. I think we will learn
more about the hormonal activity in the very near future.
In summary, I set their expectations low, recommend a
variety of modalities, and emphasize the importance of home care regimen, sun
protection and possible need for maintenance treatment.
I tell patients that we can't "cure" this condition because
it is chronic, but we can help them control the symptoms and get them to the
point where it may appear completely resolved. However, even one hour without
sun protection can bring all the symptoms back.