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Melasma is a type of hyperpigmentation that can affect the face, neck, shoulders, and upper chest regions. It is often mistaken for age spots, but it's caused by an excessive production of melanin, which causes the colouration of the skin to become uneven in tone.

While melasma is most commonly reported by women, around 10% of men will develop these dark patches of hyperpigmentation in their lifetime. If you have noticed any errant patches of darker or uneven skin, In this article, we're going to look at treatment creams and serums designed to treat this condition. But first, let’s look at what exactly causes melasma

What Causes Melasma?

Melasma is the dark pigmentation of the skin which is typically caused by hormonal fluctuations (including from hormonal treatments), sun exposure, and genetic predisposition due to family history. For those who suffer from melasma (a condition that occurs when the pigment cells of the epidermis change and create patches of discolouration on the skin), it can be difficult to find treatment options. 

People with darker skin tones are more susceptible to pigmentation problems (those of North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent), where minor skin injuries like insect bites, can cause a change in skin pigment, creating dark spots called hyperpigmentation. The symptoms of melasma can differ depending on a person’s skin tone with melasma on dark skin appearing as dark brown or grey-brown patches. These patches often appear in asymmetrical patterns on both sides of the face or other parts of the body.

There are melasma treatment creams that can help reduce melasma that uses a combination of the following ingredients: retinoids, hydroquinone, ketoconazole, Tazorac, tretinoin, azelaic acid.

Types of Melasma

There are three types of melasma, which correspond to the depth of the hyperpigmentation in the skin:

Epidermal: This presents as a dark brown colour, a well-defined border, appears obviously under black light and sometimes responds well to treatment.

Dermal: This type has a light brown or bluish colour, a hazy border, appears no differently under black light and doesn’t respond well to treatment.

Mixed melasma: This is the most common of the three, has both bluish and brown patches, shows a mixed pattern under black light, and shows some response to treatment.

Treating Melasma

Due to the complexity of its causes, melasma treatments include brightening and fading creams and serums, hydroquinone, retinoids, and chemical peels. There are also a number of in-clinic therapies that have been shown to be safe and effective melasma treatments for darker skin tones. 

Prescription-Only Creams: For a fully customised treatment from medical professionals, telemedicine providers can create melasma creams for their patients based on their lifestyles, and current skincare routine. While you can find and use over-the-counter (OTC) melasma creams, they will often contain the same ingredient mix, in the same proportions (NOT tailored to your specific needs), for most conditions. Your skin and genetic makeup are unique, which makes OTC creams largely ineffective when it comes to fading the pigmentation that comes with melasma.  

With a personalised treatment cream blended specifically for your skin’s sensitivity and tolerance, you will see a marked improvement (usually between three to six months of continuous use of the treatment) in your melasma pigmentation. 

These clinically compounded melasma creams will have a combination of the following ingredients, dependent on what other skin problems you might be addressing at the same time:

Azelaic Acid – The properties of azelaic acid are the reason it is so effective in helping to get rid of melasma. There are three main reasons why this acid is so effective in fighting this skin disease: it targets melanin, its anti-inflammatory properties reduce redness, and it has antioxidant properties that help fight free radicals.

Hydroquinone – Hydroquinone works by inhibiting tyrosinase, an enzyme involved in melanin formation. Hydroquinone is found in creams and lotions to combat the common skin condition melasma.

Tranexamic Acid – This acid, also known as TXA, is a chemical compound that has been shown to help with fading melasma. This is because TXA was found to inhibit the growth of melanin (the pigment responsible for producing skin discolouration). It also helps with inflammation and makes it easier for the other ingredients in the treatment to work.

Tretinoin – Tretinoin, a synthetic form of vitamin A, is one of the most popular medications prescribed to patients with melasma. This cream contains the active ingredient tretinoin, which is a retinoid that has anti-inflammatory properties. When combined with other important ingredients found in topical creams, it can help people get rid of dark spots and hyperpigmentation caused by melasma.

Retinol – Retinols targets a multitude of anti-aging concerns, from skin tone to laxity and texture. Once you find the right retinoid for your skin type, it smooths fine lines and wrinkles, boosts collagen production, and helps banish hyperpigmentation

Microdermabrasion: Dermabrasion is an exfoliating technique that removes several layers of the skin to treat pigmentation issues using a mildly abrasive instrument, often used for treating scarring, discolouration, sun damage, and stretch marks. A study published in the Journal of Aesthetic Plastic Surgery found that out of 410 patients with melasma, 97 per cent of them achieved persistent fading of dark patches using dermabrasion.

Microneedling: When treating melasma, microneedling is used in tandem with skin lightening creams containing a topical retinoid, vitamin C serums, or hydroquinone creams.

Medium-Depth Chemical Peel: Glycolic peels are commonly used to treat melasma, while azelaic acid reduces melasma in darker skin tones with its anti-melanin properties that act on hyperactive melanocytes.

Laser and Light Therapy: If you have dark skin, you should avoid Intense Pulsed Light (IPL) treatments, Fraxel lasers, skin-tightening lasers at the 1540 wavelength, and laser hair removal. These treatments cause trauma to the skin, which for darker tones can often result in post-inflammatory pigmentation. 

Melasma Prevention: Reducing Sun Exposure 

With sun exposure being a major contributor to developing melasma, we cannot stress the importance of sun protection. Get your hands on a broad-spectrum sunscreen, with an SPF of 30 or higher. Apply sunscreen every day, even if you aren’t going outside for very long, ultra-violet rays can pierce through cloud cover and water. A hat and sunglasses will go a long way for added protection (and style).

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