Understanding and managing Melasma

With spring already fading and the sounds of summer slowly but surely beckoning, it is time to start thinking on ways to protect ourselves and our loved ones as we enjoy our time in the sun. OLIMPIA CARMEN, Cosmetologist and Laser expert at Dubai Cosmetic Surgery clinic takes time to answer questions on Melasma, which she terms as a common skin ailment that she sees and treats on a daily basis.

1.     What is Melasma?
Melasma (or chloasma) is a common disorder of hyperpigmented patches on the skin, mostly on the sun-exposed areas of the face and neck. Although Melasma is seen in both sexes, and all races, women are the most commonly affected.

2.     What causes it?
The cause of Melasma is not fully understood but exposure to UV radiation, genetic factors, pregnancy, oral contraceptives, cosmetics, photo-toxic drugs and anti-seizure medication seem to have an important role in the appearance of this debilitating - from an aesthetic point of view - skin disorder.

3.     How common is Melasma in the Middle East Region compared to other regions?
Melasma affects all types of skin around the globe but surely, countries with stronger sun and UV radiation for most parts of the year like the Middle East have higher incidences of it compared to other areas where the sun is much less.

4.     What are the signs of Melasma?
It is proven that UV rays exposure to the skin causes oxidative damage to its components causing the skin to have "rusty" coloured patches of melanin deposits in the affected areas.

5.     Which areas of the body does this skin condition attack most?
The most involved and affected areas by Melasma include the malar area (upper cheeks), mandibular and centro-facial area. Histologically, increased pigmentation may be situated in the epidermis (surface) or deeper in the dermis, or in both of them.

6.     What treatment options are there for this skin ailment?
Current treatments for Melasma can be divided into two categories: Local treatment or external treatment, and general treatment or internal treatment.

7.     How do these treatments work?
External treatment includes application of hypopigmentation agents like hydroquinone/tretinoin, with the effect of inhibiting new production of melanin and exfoliation of the damaged layer on the surface with the use of chemical peels and laser therapy.
The internal treatment when used, is sustained by oral administration of vitamin C or/and vitamin E and intravenous injections with glutathione. The results are better and efficient although we have to consider the side-effects, and the fact that not every patient sufferer of this skin disorder is a good candidate for this treatment.  In the choice of therapies for Melasma, the specialist has to establish the risk-benefits ratio for each therapeutic modality and the patient’s history and lifestyle.
On the other hand, some people go for skin whitening creams bought locally from the supermarket or so, as well as other bleaching products. If these products are used for a very long period of time they will have some side-effects which can lead to skin atrophy, risk of depigmentation, allergic contact dermatitis, ochronosis etc.

8.      How can one manage Melasma?
Other than choosing a treatment course, one can also manage it. Melasma caused by hormonal changes, medication and continuous exposure to the sun can be improved and with patient homecare rules to follow, can be kept under control. By going this route, the condition will not become worse nor will it minimize.

9.     What can one do to protect him/herself from Melasma?
It is very important for patients to understand that treatments are sometimes long and the attention given to apply SPF SUNSCREEN cream should be taken seriously. Not to forget that sometimes by excluding some medications (e.g. contraceptive pills) or by regularly using sunscreen cream the results would be amazing.

Olimpia Carmen is also the Head of Laser and Skin Treatments Department at Dubai Cosmetic Surgery.