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Aesthetics Practice Today

Melasma – A Chronic Condition

Published February 19, 2014 5:10 PM by Mina Grasso
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 and chin.

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 the following:

  • Hydroquinone
  • Kojic Acid
  • Retinoids
  • Lactic Acid
  • Azelaic Acid
  • 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 imbalances.  

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.

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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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