- Hormonal Changes - Hormonal fluctuations, such as those experienced during pregnancy (chloasma), menopause, or while taking oral contraceptives (birth control pills), can trigger melasma. Hormone replacement therapy during menopausal years can also trigger melasma. Another hormonal imbalance condition is the polycystic ovary syndrome (PCOS) which also increases the risk of developing melasma.
- Genetic Predisposition - A family history of melasma increases the likelihood of developing melasma. Darker skin tones especially Fitzpatrick skin types III to VI (they produce more melanin), and one’s ethnic background may contribute to being more prone to pigmentation disorders.
- Environmental Triggers including medications and cosmetic products - Certain medications, including anti-convulsants, and some skincare products can heighten skin sensitivity to sunlight, thereby exacerbating melasma.
- Heat - Heat alone, even without UV rays can also trigger or worsen melasma. This includes saunas, hot yoga and kitchen activities which involve high heat, among other types of activities.
Melasma vs Other Forms of Hyperpigmentation
While melasma is a type of hyperpigmentation, it is distinct from other forms due to its specific triggers and patterns of appearance. Melasma is often more difficult to treat and needs to be dealt with differently than other forms of hyperpigmentation. Here are just two other forms:
- Post-Inflammatory Hyperpigmentation (PIH): PIH occurs when inflammation causes an increase in melanin production, such as after an injury, acne or skin irritation like eczema. When the skin heals, it leaves behind darkened spots or a discoloration. PIH can also appear anywhere on the body and presents itself as flattened spots or patches that range from tan to dark brown in colour.
- Solar Lentigines (Sunspots): These spots are caused by cumulative sun exposure over time, leading to flat, brown or black spots that typically appear on areas exposed to the sun, such as the face, hands, arms and shoulders. Often referred to as age spots or liver spots, solar lentigines are more common in older individuals.
Prevention of Melasma
Preventing melasma primarily revolves around hard-core sun protection and avoiding all known triggers:
- Use Sunscreen Diligently: Apply a broad-spectrum sunscreen with an SPF of 30 or higher every day, regardless of the weather. Reapply at least every two hours when outdoors.
- Wear Protective Clothing: Wear wide-brimmed hats, sunglasses and long-sleeved shirts to provide additional protection against UV rays. You can also look for clothing with added UV protection.
- Seek the Shade: Minimize sun exposure, especially during peak hours from 10 am to 4 pm where UV rays are at their strongest.
- Tanning Beds: Tanning beds can contribute to overall skin damage and worsen melasma.
- Heat Exposure: Intense heat from saunas, hot yoga, and hot showers can exacerbate melasma. Heat can stimulate melanocytes, leading to increased pigmentation.
- Avoid Picking or Scratching: Picking or scratching your skin can trigger inflammation which can make melasma worse.
Treatment of Melasma
These are various treatments that can help to manage and reduce the appearance of melasma:
- Medications: Prescription creams containing hydroquinone, tretinoin, corticosteroids or a combination of these can lighten melasma. These treatments should be used under the guidance of a skin specialist. Gentler options are niacinamide, kojic acid, azelaic acid and Vitamin C.
- Chemical Peels: Cosmetic procedures using glycolic or lactic acid and other chemical exfoliants can improve melasma by exfoliating and removing the top layers of skin.
- Laser and Light Therapies: Certain laser treatments can target melanin, breaking it down to be removed by the body, and subsequently reducing the appearance of melasma. Er:YAG lasers have been shown to remove superficial wrinkles, acne scars and blotchy pigmentation. Nd:YAG lasers can be used to treat hyperpigmentation and lighten overall skin tone. Pico lasers can target many skin imperfections including age spots and uneven skin tone. Specific and personalised skin therapies must be carefully chosen to optimise outcomes for each individual condition and its severity.
- Microneedling: This minimally invasive procedure involves creating micro-injuries in the skin with tiny needles, which can enhance the absorption of topical treatments and stimulate collagen production. This process can help break up excess pigmentation and help improve skin texture as well.
- Oral Medications: In certain cases, oral medications such as tranexamic acid can be prescribed to help manage melasma from within.
Melasma is arguably a persistent and challenging skin condition, but it can be effectively managed given the right knowledge and approach. By understanding its causes, taking preventive measures and seeking the appropriate treatments, you can control and reduce the appearance of melasma on your skin.
