Melasma (also called chloasma) is an aesthetic disturbance caused by the excessive production and deposition of melanin in the skin.
Melanin is the pigment produced by the melanocytes that protect us from the harmful rays of the sun.
The sun’s rays – especially its ultraviolet rays – are charged with energy which, by penetrating the skin when we expose ourselves to them, can damage the DNA of our cells.
The melanin produced by melanocytes is transferred to the keratinocytes of the epidermis in order to protect their nuclei especially from ultraviolet rays.
We know when the melanin produced by the stimulation of the sun is transferred to the epidermal cells because our skin becomes darker: i.e. we get a sun tan.
When exposure to the sun and solar stimulation is stopped, the skin gradually returns to its original colour means that the melanocytes stop producing melanin and the melanin that has already been produced slowly degrades and is eliminated.
Melasma appears as brown patches, particularly on the cheeks, forehead and upper lip; the chin and the side of the neck may also be involved.
It typically affects young women aged 30-40 years.
The colour of the patches reflects the phototype of the skin: dark and clearly evident in the case of phototype 3, and lighter and less well-defined in the case of phototype 2.
Melasma changes colour with the seasons
Although the condition remains the same, the colour of Melasma changes with the seasons. It is more obvious in the autumn, when the normal skin becomes paler and makes the patches stand out. During the winter, when the pigment of Melasma is no longer stimulated by the light, it tends to become lighter and seems to be improving; however, in the spring (March-April), the patches become darker again and more visible against the rest of the face, until it becomes tanned again in the summer and the patches become less obvious.
Melasma and its presumed causes
The real cause of Melasma is still being studied, but it is generally considered to be due to a genetic predisposition and triggering factors such as:
• Use of the contraceptive pill
• Over-exposure to the sun
• A phototoxic reaction to scented toiletries or cosmetics
However, the majority of cases have nothing to do with these presumed triggering factors because they occur in women who are not pregnant or on the pill, who have been normally exposed to the sun, and who have not used cosmetics.
Given the particular distribution of the patches of Melasma, a systemic or external cause seems unlikely because, in either case, the patches would affect the whole of the face and not take on the appearance of a continental map.
Melasma as a sign of stress
It is more logical to think that the pigment of Melasma is distributed and accumulates in specifically innervated areas of the face, such as the forehead, cheeks and around the mouth, and it would therefore seem to be due to the excitation of nerve endings in specific districts.
This excitation can be attributed to a state of stress, and it is quite common for Melasma to appear after a prolonged period of psychophysical stress.
Melasma or stress mask
It is extremely important to consider Melasma a stress mask in order to be able to treat it correctly.
First of all, it is necessary to remember that the onset of Melasma in young women is the cause of new stress and therefore leads to its worsening.
Melasma and treatment errors
The dermatological repertoire of Melasma treatments often consists of provisions that have no sense and therefore lead to no result, or invasive therapies that can actually worsen the Melasma itself.
• Lightening creams
These are creams whose active ingredients, such as hydroquinone and kojic acid, inhibit melanocytes from producing melanin. However, the melanin in subjects with Melasma has already been deposited in both the epidermis and the dermis, and so inhibiting melanocytes does not substantially change the situation and there is a risk that it may cause white vitiligo-like patches.
• Peeling with strong acids
The application of high concentrations of salicylic, glycolic and pyruvic acid causes first the detachment and then the renewal of the epidermis. Unfortunately, the pigment that causes Melasma is mainly deposited in the dermis, which is unaffected by peeling with strong acids. Furthermore, there is a high risk that the Melasma will worsen as a result of the inflammation caused by the peeling.
• Thermal energy
The aim is to treat the skin with the heat generated by laser, pulsed light and radiofrequency devices in order to promote the destruction of the Melasma pigment and thus lighten the skin. However, the inflammation caused by the thermal energy actually worsens the Melasma or leads to scarring.
• Creams or make-up with sun filters
This involves treating the areas of skin affected by Melasma by means of the all-year application of highly protective sun creams or make-up with sun filters. Unfortunately, such filters do not block all of the sun’s rays but mainly act on the small portion of UVB rays: as a result, the other rays are allowed through and the Melasma does not improve. Furthermore, using sun filters for long periods irritates the skin, which may worsen the Melasma.
Melasma can be treated using simple or combined Micropeeling, which act by accelerating the process of cell detachment and regeneration, and thus accelerating the removal of the melanin that causes Melasma.
The treatment of Melasma involves the following points:
1. Identifying stress factors and, if possible, removing or accepting them
Stress factors are usually difficult to eliminate, and drugs generally do not help. However, dermatologists have noted that when people are told that stress is the main cause of their skin disorder, they begin to accept the fact and part of the stress is dissipated.
2. Prolonged treatment
People are usually reluctant to accept lengthy treatments that do not lead to immediate results, but anyone with Melasma has no alternative as it takes 1-2 years of treatment before it goes away.
3. Changes in make-up
People with Melasma generally try to hide it with foundation cream. However, as this cream is thick, greasy and contains pigments, it is the type of cosmetic that is least tolerated by the skin under normal conditions, let alone by skin undergoing Micropeeling. Furthermore, as it slows down the process of desquamation, it make Micropeeling less effective. Instead of foundation cream, it is better to use face powder applied with a brush (if necessary more than once a day).
In the evening, make-up should be removed using a delicate foam-free cleanser (1) instead of cleansing milk.
During Micropeeling, the skin becomes drier, and it is possible to feel a sensation of pulling and see some fine scaling. If this happens, an emollient cream with vegetable oils and butters can be used in the morning(2) .
4. Simple Micropeeling
This is done using glycosalicylic lotion(3) as follows: after cleaning and drying the face, take a cotton make-up removing disc and dampen it with 7-10 drops of the lotion. Starting from the forehead, rub the disc gently over the face passing over the same areas until the disc is dry. Do not rinse and do not apply any other products.
5. Combined Micropeeling
Combined Micropeeling is used in order to accelerate the process of lightening. On one evening a week, instead of using the glycosalicylic lotion, use trans-retinoic acid(4) in the same way.
This skin vitamin accelerates the process of cell renewal and thus lightens the Melasma.
6. Seasonal Micropeeling
Unless instructed otherwise by a dermatologist, combined Micropeeling should be used from October to May, and simple Micropeeling from June to September.
7. Melasma and exposure to the sun
As mentioned above, Melasma is not caused by the sun, and so there is no reason to avoid sunlight or to use protective screening creams, which may actually react negatively with the skin (at least those with chemical filters) and worsen the Melasma. However, it is recommended to avoid any over-exposure that would cause reddening and therefore new Melasma. The exposure should take place gradually with the aid of a peaked hat and dark glasses.
8. Melasma and the contraceptive pill
Although the contraceptive pill is responsible for many problems – and therefore better avoided unless strictly necessary – there is no evidence that it is involved in causing Melasma.
Products recommended by DermaClub for the treatment of Melasma
1. MOST Cleansing Cream www.most-tc.com
2. MOST Emollient Cream www.most-tc.com
3. MOST Glicosal Lotion www.most-tc.com
4. Airol Lotion - PIERRE FABRE from pharmacies