The Difficulty of Treating Melasma

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Melasma is a discoloring skin condition which develops and heals at a gradual rate. It is difficult to treat because both epidermis and dermis are affected. Treatments require time before they are successful. Elevated estrogen levels during pregnancy help to make women vulnerable to melasma. Continued exposure to sunlight slows the healing process, frequently creating treatment resistant areas. Ultra violet light can cause darkening of the spotted areas. The best treatment is a topical combination of kojic acid or alpha arbutin cream, sun avoidance, and reduced estrogen levels.

The first and most effective treatment step is to block the light from the affected area. This is done through avoidance of exposure and prophylactic prevention methods. High-SPF sunscreens (50+)that block UVA & UVB light help to prevent development. An extensive study of 2000 pregnant Moroccan women who used SPF-50+ sunblock daily during pregnancy resulted in a less than 3% rate. The study did not have a control arm, but the results are far better than the established rates of 15-50% during pregnancy.

Chemical peel or laser treatments are only effective in about a third of cases. A third of the cases see no change, and third show an increased amount of pigmentation (hyperpigmentation).

The microdermabrasion treatment method vacuums very fine crystals across the skin using pressure from a tiny vaccum cleaner like tip. Instead of crystals, newer versions use tiny diamond chips embedded in the tip to create the abrasion. The newer crystal free versions are better, but not an essential requirement for treatment. The newer systems allow the infusion of therapeutic agents during the microdermabrasion treatment process. Salacylic acid (the active ingredient in aspirin) is an agent used to clean the pores during a treatment.

Too aggressive microdermabrasion treatment for one’s pigment or skin sensitivity level will cause complications. Gentler treatments like mild, natural bleaching creams over a longer time period are more effective. Generally microdermabrasion is not recommended for treating melasma. It does help with the appearance of melasma on epidermis, though.

Plant based compounds alpha arbutin, thymol, and kojic acid inhibit pigment production. These natural compounds, referred to as “skin bleaching ingredients, are effective in improving the appearance. When they are combined with sun avoidance and reduced estrogen levels, will effectively treat a difficult outbreak of melasma.