MELASMA: Treatment
Melasma is a hypermelanosis confined to the skin that is exposed to sunlight. Although melasma can affect any ethnic background, it is much more common in people with darker skin, especially with Asians and Hispanics living in areas with intense exposure to solar ultraviolet radiation. The pathophysiology of melasma is not yet understood exactly, but there are certain factors that seem to be involved in this condition.
Definition
It consists of the presence of a hypermelanosis generally equally on both sides of the face. When it occurs to women during pregnancy, the skin on the face darkens. Although it can affect anyone, melasma affects women more than men, especially when they are pregnant and had previously used oral contraceptives (“the pill”) or hormones during HRT.
Risk factor's
Factors that influence the appearance of melasma are:
- Anovulatory
- Pregnancy
- Genetics
- Sun Exposure
- Menopause
- Cosmetics: certain makeups, moisturizers and other beauty products may have an irritating effect on predisposed persons.
- Endocrine: Melasma may be a manifestation of a endocrinological condition such as diabetes mellitus.
Types of Melasma
There are three types of melasma, depending on the depth at which the melanin is located by using Wood’s Lamp Examination (transillumination light).
- Melasma of the Skin: melanin is located on the superficial dermis. Tends to have fuzzy edges and is usually located in the region of the zygomatic bone. Its color is bluish black under the woods light examination.
- Epidermal Melasma: melanin is situated on the basal epidermal layers. It presents clear borders and is often distributed on the central facial area. It is the type of melasma that best responds to treatment if a dark brown color is seen under the woods light..
- Mixed Melasma: combines the features of dermal and epidermal melasma.
- Physiologic Melasma due to Pregnancy: It is usually transient and responds well to treatment.
As far as keloids, is cosmetic surgery a reliable treatment?
The dermatologist with experience know that you can not make mistakes because otherwise exacerbate the problem. Correct diagnosis and not confuse it with muscle cutaneous tumors. We have a protocol which I updated with optimized experience, assessing the effectiveness of these: Age of keloid, location, whether it is active (itchy rash) evaluate the different options: cryosurgery + corticosteroid injections, injections of bleomycin, vascular laser, excision and radiotherapy immediately taken therapy etc.
What are the surgery risks for those patients who have a history of anti aesthetic scars?
The surgeon must conduct deep sutures in his intervention and grip the superficial cutaneous tissues to eliminate tension. In addition the application of compression bandages and a silicone gel is completed. A follow up visit is scheduled to control wounds at 1 and 2 months to treat scars immediately if they are healing inadequately.
Diagnosis
The dermatologist can identify the melasma easily thanks to its typical shape and color without other underlying symptoms. Sometimes it may be necessary for your doctor to perform a blood test to rule out other diseases.
A test that can help diagnose melasma skin is observed through the Woods Light Examination, a lamp that highlights areas of the skin that have an excess of melanin.
When skin changes resemble other diseases and there is no assurance of being a melasma, a biopsy of the tissue is performed for examination under a microscope.Because of its resemblance to melanomas, pigmented carcinomas or solar lentigo a biopsy is conducted along with a histochemical staining technique to resolve these difficult cases.
Treatment for Melasma
On many occasions the melasma will disappear spontaneously without treatment. On those instances where treatment is required, we now have:
- Hydroquinone: Is normally the first active ingredient that is used in cases of melasma. Acts overnight by clarifying the skin that has excessive pigmentation.
- Tretinoin: can be used alone or with hydroquinone
- Corticosteroids: These creams can also have a lightening effect on the skin, but the concentration of corticosteroids should be small to avoid long-term side effects.
- Other products: Creams containing azelaic acid or kojic acid also have skin lightning effects.
- Custom-made formulas are important following the advice of a dermatologist to avoid excessive irritation that may worsen melasma.
- Chemical peel or microdermabrasion: Will remove surface layers of the skin. With several spaced out sessions it can remove excess pigmentation in certain areas.
- Laser sessions: Using low power laser can help the progressive skin lightening, combined with the use of the creams mentioned before.
- Non-hormonal contraception can be used when the underlying cause of melasma is most probably an alteration of the female hormonal cycle.
- Sun Protectors should not be suspended in the treatment.
- Treatments are performed in Corachan Clinic and Beautyderm.
Doctor Pablo Umbert