The skincare industry has experienced a remarkable boom in recent years, with trends shifting like the wind and exciting breakthroughs in treating various skin conditions. Why the buzz, you ask? Well, society's keen focus on achieving clear, flawless skin has fueled this skincare revolution. Take melasma, for example. Medical treatment for melasma now has a variety of options, ranging from user-friendly topical solutions to cutting-edge laser therapies and even oral systemic medications.
Now, here's the intriguing part: while melasma doesn't pose physical health risks, it casts a shadow on the emotional well-being of those affected. Numerous studies have uncovered the profound impact on mental health, causing emotional turmoil and psychological distress. This brings us to a crucial point – it's high time we shed light on this hidden struggle and find a solution.
Unveiling the Mystery of Melasma
For better understanding, we need to peel the layers of the problem and know the important things about melasma. Melasma is all about hyperpigmentation, causing dark spots and patches. It's like an unwelcome guest on your face, often making itself at home on the cheeks, neck, and shoulders.
Melasma is a prevalent skin disorder of hyperpigmentation that affects women, especially in higher-risk groups like those with darker skin tones. It is also known as the “mask of pregnancy,” as it can be triggered by hormonal changes during pregnancy, but this is not the only thing that can cause it.
The Triggers: Hormones, Genetics, and More
The exact cause of melasma is complicated and involves several pathways that are implicated in the induction of hyperpigmentation. One of the main factors that is found to contribute to the development of melasma is radiation, which can be radiation from the sun, visible light, or infrared light. This is a response to protect the skin from excessive ultraviolet exposure. Other possible causes of melasma include:
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Certain medications, like anti-seizure medications, contraceptives, estrogen/diethylstilbestrol, or a synthetic form of the hormone estrogen
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Hormonal changes, such as in pregnancy
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Genetics can also play a part in the acquisition of this condition
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Phototoxic drugs that make the skin more sensitive to sunlight can also be a cause of melasma
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Other causes can also include tanning beds, LED screens, or even makeup that may cause a phototoxic reaction
Identifying Melasma
Melasma is like a secret code written on your skin, revealing itself through patches of brown, dark brown, or even bluish spots. Let's break it down for a clearer understanding:
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Centrofacial Melasma: The classic kind, spreading its artistic touch across the central face.
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Malar Melasma: Keep an eye on the nose and cheeks – that's where this melasma likes to shine.
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Lateral Cheek Patterns: Spots on both sides of your cheeks? You might be dealing with this melasma variant.
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Mandibular Melasma: It's all about the jawline drama with this one.
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Brachial Melasma: Watch out for a melasma trail – it could extend from your shoulders to the upper arms.
Melasma can also be characterized based on the depth of the melanin deposition in the epidermis, dermis, or mixed.
When in Doubt, Consult
Not all brown patches are melasma's handiwork. For a precise diagnosis and effective treatment, a chat with a healthcare provider is key.
Melasma can seem a bit scary, especially to those who may only be experiencing it for the first time and do not have any idea how to go about treating it. Some may also say that having melasma can lead you to have cancer; this is simply not true. Melasma isn't a horror story and it won't lead to cancer. This misconception might stem from its visual resemblance to certain skin cancers. The best move? Seek professional advice.
Treatment for Melasma
Melasma can seem a bit scary, especially to those who may only be experiencing it for the first time and do not have any idea how to go about treating it. Some may also say that having melasma can lead you to have cancer; this is simply not true. Melasma is not cancerous, nor is it a skin condition that can progress into cancer. This idea may only have the connotation that other skin cancers appear to have the same qualities as melasma, so the best way to go about it would still be consultation with healthcare professionals.
For people who have melasma, the million-dollar question remains: Is medical treatment for melasma worth the risks? Although it might require some time and a couple of sessions, treatments for melasma can be highly effective, especially when guided by a dermatologist. These treatments include an array of topical and oral medications, aside from treatments and clinical procedures, depending on the possible triggers or causes.
Topicals
Topical treatments often provide the most cost-effective treatment options and are most accessible to most patients.
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Photoprotection from harmful UV rays remains one of the cornerstones of melasma treatment. It is also vital in preventing the recurrence of melasma, which happens quite often. Using tinted broad-spectrum sunscreens and sunblocks with
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Tranexamic acid: Topical tranexamic acid is as effective as the cumulative effect of hydroquinone in treating melasma, providing a safer alternative with significant therapeutic benefits.
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Botanicals such as Rumex occidentalis, a perennial herb, are recently being studied as skin-lightening agents. A clinical trial conducted in the Philippines found that a 3% cream of R. occidentalis is a safe and effective agent for melasma, and its efficacy is comparable with that of 4% Hydroquinone cream.
Summary of Novel Topical Therapies
Below are some of the newer topical therapies that have shown ef
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Therapies |
Mechanism of Action |
Safety in Pregnancy |
Adverse Effects |
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Cysteamine |
Tyrosine inhibitor, ROS inhibitor |
Unclear |
Irritation, pruritus, |
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Topical methimazole |
Peroxidase inhibitor |
Unclear (oral methimazole is used in pregnancy) |
Erythema, burning, and dryness |
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Topical metformin |
Antidiabetic medication, decreases cyclic adenosine monophosphate (cAMP) |
Safe |
Burning |
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Exosomes |
Regulate the expression of genes involved in pigmentation, expression of tyrosinase, and the development and migration of melanocytes |
Unclear |
None |
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Adapted from: Li, Pastukhova, & Dover, 2023; Cho, et al., 2020 |
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Oral Medications
Oral medications are also viable options in the medical treatment for melasma patients. However, these medications all come with their risks and possible side effects. It is vital to never start taking any medication without consulting your physician first.
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Oral tranexamic acid is superior to topical tranexamic acid when it comes to reducing the appearance of melasma. Because it is intended as a treatment for other conditions, the occurrence of side effects can be common and can include gastrointestinal disturbance, headache, ringing of the ears, and headache. More severe adverse events such as deep vein thrombosis (DVT), acute renal cortical necrosis, acute myocardial infarction, and pulmonary embolism can be rare but still occur, emphasizing the importance of never self-medicating.
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Antioxidants such as vitamins C and E have always been a staple in treating hyperpigmentation agents. They protect the cells from oxidative damage caused by external factors such as UV light exposure, thus minimizing its harmful effects on the skin. Other agents include glutathione and melatonin.
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Pynocare is the first-ever FDA-approved oral medicine in the Philippines for melasma that is clinically proven safe and effective in reducing the appearance of dark spots caused by melasma. It is composed of procyanidin, which is antioxidant and anti-inflammatory and is several times more potent than vitamin C and E as antioxidants and can also recycle vitamin C and regenerate vitamin E; beta-carotene, which works great in supporting skin nourishment from deep within the skin; ascorbic acid, a widely used ingredient in reducing pigmentation; and d-alpha-tocopheryl acetate, which protects the skin from sun damage since it is one of the main causes of melasma. In as fast as 8 weeks, Pynocare has been shown to reduce melasma appearance in those experiencing melasma. The best thing about it is that it can be taken as a preventive measure to prevent melasma from recurring or ever occurring in the first place.
Chemical Peels
Chemical peels are also one way to go if topical treatments provide less satisfactory results. Chemical peels promote the shedding of toxic and irritated skin layers to regrow a new and fresher skin surface that is more evenly colored. Chemical peels also supply the skin with much-needed elastin and collagen. The type and concentration of chemical agent to be used would greatly depend on the depth of penetration needed, classified as either superficial, medium-depth, or deep.
Laser Therapy
Laser treatments are light-based procedures that emit high-intensity light that effectively targets, breaks apart, and removes discoloration from the skin. Laser treatments vary; some may also use heat beams that target small sections of the skin to promote cell production. This photothermal effect and subsequent inflammation may lead to paradoxical post-inflammatory hyperpigmentation (PIH). So, the choice of laser type and treatment regime should be considered very carefully in patients with skin of color. It should be noted that laser therapy should generally not be used as monotherapy in the treatment of melasma.
Other Procedures and Adjunctive Treatments
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Microdermabrasion can be a good option for melasma that isn’t too deep. The procedure exfoliates the top layers of the skin and stimulates skin cell renewal. This procedure also enhances the delivery of topical treatment. One study showed that microdermabrasion, when combined with 70% glycolic acid peel, is more effective than glycolic acid peel alone.
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Microneedling
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Platelet-rich
Embracing radiant lives
Melasma, with its intricate layers, demands attention. It's not just about dark spots on the skin; it's a complex interplay of emotions and self-esteem. The psychosocial well-being and quality of life of those with melasma deserve our focus, compassion, and a resolution to this often underestimated problem.
Despite all these effective medical treatments for melasma, the desired outcome does not happen overnight—results take time, naturally. It is important to really understand the procedures that need to be done and the medications that need to be taken and to consider the risks that come along with them.
References
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Cho, B. S., Lee, J., Won, Y., Duncan, D., Jin, R. C., Lee, J., Kwon, H. H., Park, G. H., Yang, S., Park, B. C., Park, K. Y., Youn, J., Chae, J., Jung, M., & Yi, Y. W. (2020). Skin Brightening Efficacy of Exosomes Derived from Human Adipose Tissue-Derived Stem/Stromal Cells: A Prospective, Split-Face, Randomized Placebo-Controlled Study. Cosmetics, 7(4), 90. https://doi.org/10.3390/cosmetics7040090
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Grimes, P. E., Ijaz, S., Nashawati, R., & Kwak, D. (2019). New oral and topical approaches for the treatment of melasma. International Journal of Women’s Dermatology, 5(1), 30–36. https://doi.org/10.1016/j.ijwd.2018.09.004
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Li, H. O., Pastukhova, E. N., & Dover, J. S. (2023). Update on Melasma management. Advances in Cosmetic Surgery, 6(1), 193–211. https://doi.org/10.1016/j.yacs.2022.10.003
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Mendoza, C. G., Singzon, I. A., & Handog, E. B. (2014). A randomized, double‐blind, placebo‐controlled clinical trial on the efficacy and safety of 3% Rumex occidentalis cream versus 4% hydroquinone cream in the treatment of melasma among Filipinos. International Journal of Dermatology, 53(11), 1412–1416. https://doi.org/10.1111/ijd.12690
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Sadeghpour, M., Dover, J. S., & Rohrer, T. E. (2018). Advances in the treatment of melasma. Advances in Cosmetic Surgery, 1(1), 163–174. https://doi.org/10.1016/j.yacs.2018.02.008
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Thakur, A., Shah, D., Rai, D., Parra, D. C., Pathikonda, S., Kurilova, S. A., & Cili, A. (2023). Therapeutic values of exosomes in cosmetics, skin care, tissue regeneration, and dermatological diseases. Cosmetics, 10(2), 65. https://doi.org/10.3390/cosmetics10020065
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Zhou, L. (2020). 18479 Melasma: A systematic review of the systemic treatments. Journal of the American Academy of Dermatology, 83(6), AB214. https://doi.org/10.1016/j.jaad.2020.06.943
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Nair, P., & Tandel, J. J. (2021). Microneedling: A means of collagen induction therapy. Journal of Dermatology and Dermatologic Surgery, 25(2), 49. https://doi.org/10.4103/jdds.jdds_126_20
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Abdel-Motaleb, A. A., & Bakr, R. M. (2021). Microdermabrasion assisted delivery of glycolic acid 70% peel for the treatment of melasma in dark‐skinned patients. Dermatologic Therapy, 34(4). https://doi.org/10.1111/dth.15025
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Guan, L., Lim, H. W., & Mohammad, T. F. (2021). Sunscreens and Photoaging: A review of Current literature. American Journal of Clinical Dermatology, 22(6), 819–828. https://doi.org/10.1007/s40257-021-00632-5
REFERENCES FOR TABLE 1
Cysteamine
2018 Case Report:
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Kasraee, B., Mansouri, P., & Farshi, S. (2018). Significant therapeutic response to cysteamine cream in a melasma patient resistant to Kligman’s formula. Journal of Cosmetic Dermatology, 18(1), 293–295. https://doi.org/10.1111/jocd.12837
2020 RCT:
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Karrabi, M., David, J., & Sahebkar, M. (2020). Clinical evaluation of efficacy, safety and tolerability of cysteamine 5% cream in comparison with modified Kligman’s formula in subjects with epidermal melasma: A randomized, double‐blind clinical trial study. Skin Research and Technology, 27(1), 24–31. https://doi.org/10.1111/srt.12901
Topical Methimazole
2020 RCT:
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Gheisari, M., Dadkhahfar, S., Olamaei, E., Moghimi, H. R., Niknejad, N., & Najar Nobari, N. (2020). The efficacy and safety of topical 5% methimazole vs 4% hydroquinone in the treatment of melasma: A randomized controlled trial. Journal of cosmetic dermatology, 19(1), 167-172. https://doi.org/10.1111/jocd.12987
Topical Metformin
2020 Preliminary Clinical Trial:
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Banavase Channakeshavaiah, R., & Andanooru Chandrappa, N. K. (2020). Topical metformin in the treatment of melasma: A preliminary clinical trial. Journal of Cosmetic Dermatology, 19(5), 1161-1164. https://doi.org/10.1111/jocd.13145
2020 RCS:
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AboAlsoud, E. S., Eldahshan, R. M., AbouKhodair Mohammed, H., & Elsaie, M. L. (2022). Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman's formula) in treating melasma: A randomized controlled study. Journal of Cosmetic Dermatology, 21(6), 2508-2515. https://doi.org/10.1111/jocd.14953
Article Reviewed by: Dr. Mary Amy Fatima Cagayan Chua
