Melasma Hyperpigmentation

Dr Abi
Apr 28, 2023
7 min read

Melasma

Melasma is a common acquired hyperpigmentation disorder that occurs predominantly in women, especially during pregnancy or while taking hormonal contraceptives.

Melasma is a multifactorial condition, where both genetic and environmental factors, including UV radiation, hormonal changes, and inflammation, play a role in its pathogenesis.

Clinical Features of melasma

Melasma is a common skin condition that is characterized by the development of brown or gray-brown patches or macules on the face, particularly on the cheeks, forehead, nose, upper lip, and chin.

The patches are typically symmetrical and have irregular borders. Melasma can occur in all skin types but is more commonly seen in individuals with Fitzpatrick skin types III to VI.

Melasma is generally categorized into three clinical patterns, based on the location of the lesions:

1. Centrofacial melasma: This is the most common pattern of melasma and involves the central part of the face, including the forehead, cheeks, nose, and upper lip.

2. Malar melasma: This pattern involves the cheeks and is less common than centrofacial melasma.

3. Mandibular melasma: This pattern involves the jawline and chin and is the least common type of melasma.

The color and intensity of the lesions may vary from light brown to dark brown or gray-brown. The pigmentation is typically located in the epidermis (outermost layer of the skin) but can also involve the dermis (deeper layer of the skin).

Pathogenesis of Melasma

The pathogenesis of melasma is complex and multifactorial, involving a combination of genetic, hormonal, and environmental factors. The exact mechanisms that lead to the development of melasma are not fully understood, but several theories have been proposed. One of the primary factors implicated in the pathogenesis of melasma is the overproduction and accumulation of melanin in the skin. Melanin is the pigment that gives color to the skin, and its production is regulated by melanocytes, which are specialized cells located in the basal layer of the epidermis. In individuals with melasma, the melanocytes produce more melanin than usual, leading to hyperpigmentation.

Several factors can trigger the production of excess melanin in melasma, including:

1. Ultraviolet (UV) radiation: Exposure to UV radiation from the sun or artificial sources, such as tanning beds, can trigger the production of melanin in the skin, leading to the development of melasma. UV radiation is believed to stimulate the production of pro-inflammatory cytokines and increase the activity of enzymes involved in melanin synthesis.

2. Hormonal factors: Hormonal changes, such as those that occur during pregnancy, menopause, or with the use of hormonal contraceptives, can also trigger the development of melasma. Estrogen and progesterone have been shown to stimulate the production of melanin in the skin, and their levels may be elevated during these hormonal changes.

3. Genetic factors: There is evidence to suggest that genetic factors may play a role in the development of melasma. Several genes involved in melanin synthesis and regulation have been implicated in the condition.

4. Other factors: Other factors that may contribute to the development of melasma include skin irritation, certain medications, and medical conditions that affect the endocrine system.

evaluation of skin in early years can save yourself from melasma

Overall, the pathogenesis of melasma is believed to involve a complex interplay between genetic, hormonal, and environmental factors, leading to the overproduction and accumulation of melanin in the skin.

Further research is needed to fully understand the mechanisms involved in the development of melasma and to develop more effective treatments for the condition.

Treatment of Melasma

The treatment of melasma is challenging and often requires a multifaceted approach. There are several treatment options available for melasma, including topical agents, chemical peels, and laser therapy.

However, the effectiveness of these treatments can vary depending on the severity of the condition and the individual's skin type and response to treatment.

Here's an overview of the treatment options for melasma:

1. Topical agents: Topical agents are the first-line treatment for melasma. They work by inhibiting the production of melanin in the skin and reducing the appearance of hyperpigmentation. The most commonly used topical agents for melasma include hydroquinone, tretinoin, and corticosteroids.

Hydroquinone is a tyrosinase inhibitor that blocks the production of melanin in the skin. It is available in concentrations ranging from 2% to 4% and can be used alone or in combination with other topical agents.

Tretinoin is a retinoid that promotes skin cell turnover and reduces the appearance of hyperpigmentation. It is often used in combination with hydroquinone for the treatment of melasma.

Corticosteroids, such as fluocinolone acetonide, can be used in combination with hydroquinone and tretinoin to reduce inflammation and promote skin lightening.

2. Chemical peels: Chemical peels are another option for the treatment of melasma. They work by exfoliating the outer layer of the skin and reducing the appearance of hyperpigmentation. The most commonly used chemical peels for melasma include glycolic acid, salicylic acid, and trichloroacetic acid.

3. Laser therapy: Laser therapy can also be used for the treatment of melasma. It works by targeting melanin in the skin and reducing the appearance of hyperpigmentation. The most commonly used lasers for the treatment of melasma include Q-switched Nd:YAG and fractional lasers.

4. Sun protection: Sun protection is an essential component of the treatment and prevention of melasma. UV radiation can trigger the production of melanin in the skin and worsen the appearance of hyperpigmentation. Sunscreen with a broad-spectrum SPF of at least 30 should be applied daily and reapplied every 2 hours when exposed to sunlight.

5. Alpha arbutin

-It is a naturally occurring compound that is often used as a skin lightening agent in topical formulations. It works by inhibiting the activity of tyrosinase, which is an enzyme involved in the production of melanin.

-Alpha arbutin has been studied for its potential to improve the appearance of hyperpigmentation, including melasma.

-Several studies have suggested that alpha arbutin can be an effective treatment for melasma when used in combination with other topical agents such as hydroquinone, tretinoin, and kojic acid.

-In a randomized controlled trial, a topical formulation containing 2% alpha arbutin, 1% kojic acid, and 0.05% tretinoin was found to be as effective as a combination of 4% hydroquinone and 0.05% tretinoin in reducing the severity of melasma.

6. Niacinamide

-Niacinamide, also known as vitamin B3, is a water-soluble vitamin that has been studied for its potential to improve the appearance of various skin conditions, including hyperpigmentation such as melasma.

-Several clinical studies have suggested that niacinamide can be effective in reducing the severity of melasma.

-In a randomized controlled trial, a combination of 4% niacinamide and 2% tranexamic acid was found to be as effective as a combination of 4% hydroquinone and 0.05% tretinoin in reducing the severity of melasma after 12 weeks of treatment.

7. Tretinoin

-Tretinoin, also known as all-trans-retinoic acid, is a derivative of vitamin A that has been shown to be effective in the treatment of several skin conditions, including melasma.

-Tretinoin works by increasing the turnover of skin cells, promoting the growth of new, healthy cells and reducing the appearance of hyperpigmentation.

-One of the key mechanisms by which tretinoin helps in melasma is by increasing the shedding of melanin-containing cells from the skin's surface. This helps to reduce the buildup of melanin in the epidermis and decrease the severity of hyperpigmentation.

-In addition, tretinoin can also stimulate collagen production and improve skin texture and elasticity, which can lead to an overall improvement in the appearance of the skin.

8. Kojic acid

-Kojic acid, is a naturally occurring substance that is produced by certain species of fungi, such as Aspergillus oryzae. It has been studied for its potential to reduce hyperpigmentation, including melasma.

-Kojic acid works by inhibiting the activity of tyrosinase, an enzyme that plays a key role in the production of melanin in the skin. By inhibiting tyrosinase, kojic acid can help to reduce the formation of melanin and therefore decrease the severity of hyperpigmentation.

-Several studies have suggested that kojic acid can be effective in reducing the severity of melasma. For example, a randomized controlled trial found that a cream containing 2% kojic acid, 10% glycolic acid, and 2% hydroquinone was effective in reducing the severity of melasma after 12 weeks of treatment.

9. AHAs and BHAs

-In addition to their exfoliating properties, AHAs and BHAs have also been shown to have some potential for reducing hyperpigmentation in the skin.

-For example, a study published in the Journal of Cosmetic Dermatology found that a cream containing glycolic acid and salicylic acid was effective in reducing the severity of melasma after 12 weeks of treatment.

10. Tranexamic acid

-Tranexamic acid can be administered topically for the treatment of melasma. Topical formulations typically contain concentrations of 2-5%.

-Several studies have suggested that tranexamic acid can be effective in reducing the severity of melasma.

-For example, a study published in the Journal of Cosmetic Dermatology found that a topical formulation containing 3% tranexamic acid was effective in reducing the severity of melasma after 12 weeks of treatment. Another study published in the Journal of Dermatological Treatment found that oral tranexamic acid was effective in reducing the severity of melasma after 12 weeks of treatment.

11. Cysteamine

-Cysteamine is typically used topically to treat hyperpigmentation disorders such as melasma, as well as other skin conditions such as acne and rosacea.

-Cysteamine works by inhibiting the activity of the tyrosinase enzyme, which is involved in the production of melanin. By reducing the amount of melanin produced by the skin cells, cysteamine can help to lighten areas of hyperpigmentation and improve the overall appearance of the skin.

-Cysteamine is generally well-tolerated and has few side effects when used as directed.

In summary, the treatment of melasma typically involves a combination of topical agents, chemical peels, laser therapy, and sun protection. The choice of treatment depends on the severity of the condition and the individual's skin type and response to treatment.

References

1. Topical Treatments for Melasma and Their Mechanism of Action

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122278/ 2. Update on Melasma—Part II: Treatment

3.Medical therapies for melasma

4. Topical therapies for melasma and disorders of hyperpigmentation

5. Huerth KA, Hassan S, Callender VD. Therapeutic Insights in Melasma and Hyperpigmentation Management. J Drugs Dermatol. 2019;18(8):718–729. Aug 1. [PubMed] [Google Scholar]

6. Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724303/

7. Topical tranexamic acid as a promising treatment for melasma https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235096/

8. Chemical Peels for Melasma in Dark-Skinned Patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560164/

9. Topical Stabilized Cysteamine as a New Treatment for Hyperpigmentation Disorders: Melasma, Post-Inflammatory Hyperpigmentation, and Lentigines

https://pubmed.ncbi.nlm.nih.gov/34898155/

10. Ortonne JP, Arellano I, Berneburg M et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009;23(11):1254–1262. Nov. [PubMed] [Google Scholar]

Author-

Dr. Abi Negi

Dentist

10 + years of experience

Certification in Practical Implantology

Certification in Rotary Endodontics

Associate Fellowship in Laser Dentistry Certification in Laser Treatments Diploma in Practical Occlusion and Restorative Dentistry Course Advanced occlusion appliance therapy, TMD Comprehensive Course in Veneers - Ceramic & Composite Aesthetic Certified - Europe, Germany WHO Health Program Certified Certification in Laser Dentistry Fellow of the Academy of General Education (FAGE) Member of the Indian Dental Association (IDA)