Ask the Expert: Melasma
Written by Dr Justine Kluk for Doctify
What is melasma?
Melasma is a common disorder of facial pigmentation. It typically appears for the first time between the ages of 20 and 40 and is more likely to affect those with darker skin types or tanned skin. Ninety percent of sufferers are female and, in most cases, melasma is thought to be triggered by pregnancy, hormonal medication e.g. the contraceptive pill and medical conditions that cause altered hormone levels.
The exact process isn’t fully understood; however we know that the increase in facial pigmentation seen in melasma is due to excess production of melanin by melanocytes (the pigment-generating cells in our skin). Exposure to ultraviolet radiation in sunlight deepens the pigmentation by activating the melanocytes to produce more melanin.
How might it affect me?
Melasma can be recognised by the appearance of blotchy dark brown or grey patches on the face. They tend to occur on the forehead, cheeks, upper lip and nose and are usually symmetrical. In some cases, the skin may also be a little bit red at the onset.
Many of those who suffer with melasma first become aware of it during the summer months when increased exposure to ultraviolet (UV) radiation causes the discolouration to become more noticeable. Because of the association with hormones, especially during pregnancy, it is sometimes referred to informally as the “mask of pregnancy” or “pregnancy veil.”
As with other visible facial skin conditions such as acne and rosacea, melasma sufferers often report feelings of embarrassment and anxiety which may lead to withdrawal from social situations.
What are the treatments?
The most effective way to manage melasma combines avoidance of known triggers with active treatment.
- Identification of exacerbating factors. Whilst there is little one can do at the time when melasma occurs for the first time or flares during pregnancy, women taking hormonal contraception may wish to discuss alternative contraception methods with their doctor.
- Sun protection. Think about the most careful you’ve ever been in the sun…and then think about being even more careful than that! Successful treatment of melasma hinges on strict sun avoidance. Apply sunscreen 365 days per year before leaving the house and top up every couple of hours if you are going to be spending time outside. At times of peak UV radiation e.g. between noon and 2pm, wear a hat with a wide brim for extra protection if you are planning to be outdoors. It only takes a few minutes of sun exposure without adequate protection to undermine weeks and weeks of active treatment.
- Skin lightening creams. Prescription creams containing a retinoid (vitamin A derivative) or the skin lightening agent, hydroquinone, can be used to help fade the dark patches. Any treatment regime that utilises these prescriptions should be started at the end of the summer as they can increase sensitivity to the sun. For the same reason, these creams are usually applied at night before bedtime. Redness and peeling are common in the initial stages of treatment and can be avoided by introducing the products gradually.
- Chemical peels. As with skin lightening creams, these treatments are often performed during autumn and winter as they can increase the skin’s sensitivity to the sun. There may be downtime associated with this sort of treatment.
- Laser treatment. This may be helpful in some cases, but studies indicate that results are variable.
It is important to remember that there are a number of skin disorders that affect facial pigmentation. Treatment for these other disorders will be different. A consultant dermatologist is the only doctor expert in the diagnosis and treatment of skin disease. Please make sure you are receiving advice from someone qualified to give it.
Is there anything I can do?
The following self-help tips may be of use. For further guidance, consider seeking the advice of a dermatologist who has a particular interest in melasma.
- Use a gentle skin cleanser. Some of the treatments for melasma, such as retinoids or hydroquinone, can cause skin irritation in the early phases. Keeping skincare simple can help alleviate this.
- When choosing your sunscreen, pick a product that is broad spectrum (UVA and UVB) and has an SPF of 50 or more. Physical sunscreens i.e. containing zinc oxide or titanium dioxide may offer protection against visible light as well as UV radiation, which is relevant in some cases of melasma.
- It is possible to cover or disguise melasma with make-up in many cases. Furthermore, mineral make-up products may offer an additional layer of sun protection. If you are still struggling to get the right cover, charities such as Changing Faces offer a self-referral Skin Camouflage service and can also put you in touch with other sufferers so that you can share advice.
Dr Justine Kluk is a London-based consultant dermatologist with boutique private dermatology clinics in Hampstead Garden Suburb and Harley Street. She is renowned for her less-is-more approach to anti-ageing and skin rejuvenation, and is also passionate about relieving the stress and anxiety of skin disorders such as melasma, acne and rosacea.