Melasma: how to get rid of it with tips from Dermaclub

Melasma (chloasma) is an aesthetic skin condition caused by the excessive production and deposition of melanin in the skin.
The melanin pigment is created to provide protection from the sun’s harmful rays.
Solar rays, and especially ultraviolet (UV) rays, are full of energy and can even damage DNA by penetrating the skin during sun exposure.
Melanin is produced by melanocytes and is then converted into keratinocytes (cells of the epidermis) to protect the cells’ nucleus’ from UV rays.

With stimulation from the sun, melanocytes produce melanin which is then transferred to the cells of the epidermis, causing our skin to tan and become darker.
After sun exposure, the skin gradually returns to its original color because, in the absence of solar stimulation, melanocytes stop producing melanin and any existing melanin slowly degrades and disappears.

Melasma

Melasma causes the formation of brown spots, most often on the cheeks, forehead and upper lip. The chin or side of the neck can also be affected.
Melasma typically occurs in young women between 30 and 40 years old.

The color of melasma spots depends on an individual’s phototype. In those with phototype 3, melasma spots are dark and very noticeable, while in individuals with phototype 2, they are lighter and more subtle.

Melasma and seasonal color changes

Although melasma actually remains the same, the spots will change color depending on the seasons. Melasma spots will be more noticeable after the summer, when unaffected skin lightens and that which is affected by melasma does not, causing a clear contrast. In winter, the melasma pigment is no longer stimulated by light, meaning the spots tend to lighten and the condition appears to fade. However, as early as March or April, the melasma pigment will darken once again and will create a noticeable contrast with untanned skin. The cycle continues when summer comes round again, and when the increased sun exposure of these months tans the skin, which somewhat masks melasma.

Presumed causes of melasma

The actual causes of melasma are still being studied today. It is thought, however, that there is a genetic predisposition to developing the condition, as well as certain triggering factors including:

• Pregnancy
• The contraceptive pill
• Sun exposure
• Phototoxic reaction to perfumes, cosmetics and/oe sun creams

Interestingly, however, melasma is most often noted in those without any of the above factors.
Indeed, when looking at the very particular arrangement of melasma spots, it is difficult to think of a systemic or, much less, external cause of the condition.
If the cause were external, spots would be spread over the entire face and would not have the splotchy, unevenness that characterizes melasma spots.

Melasma and stress

The melasma pigment is more likely to be distributed and to accumulate in specific areas of innervation of the face, such as, the forehead, cheeks or peribuccal areas.
Melasma’s anomalous pigmentation is the consequence of the excitation of some nerve endings in these particular zones.
Nervous excitation can be traced back to higher levels of stress in an individual, with melasma often appearing after a prolonged period of psychophysical stress.

Melasma: a mask of stress

It is important that melasma is considered as a stress mask so that the correct treatment can begin.
Moreover, it is particularly important to consider melasma as an additional cause of stress, which will therefore aggravate the condition.

Melasma treatment mistakes

Many of the proposed treatments for melasma are not suitable. At best, they do nothing and, at worst, they can actually worsen melasma.

• Lightening creams
  These creams contain active ingredients, such as hydroquinone and kojic acid, that block the melanocytes’ production of melanin. In melasma, however, melanin has already been deposited in both the epidermis and the dermis, therefore inhibiting melanocytes function does not make any substantial changes and can increase the risk of vitiligo-like white patches forming.
• Peeling
  Peeling using high concentrations of salicylic, glycolic or pyruvic acids causes the epidermis to shed and renew. However, the pigment that causes melasma is mainly deposited in the dermis where peeling acids cannot act. In addition, the inflammation that peeling can cause may worsen melasma.
• Thermal therapies
  Laser therapy, intense pulsed light (ITL) or radiofrequency can destroy melasma and can lighten the skin. However, inflammation can worsen melasma and can result in scarring.

Sunscreens (in creams or make-up)
Individuals with melasma are also recommended to protect their skin from the sun’s rays using sunscreen with chemical filters. However, this advice is misguided, as sunscreens only filter some of the sun’s rays and can be poorly tolerated with the skin. Long term use can cause skin damage and sensitivity, accompanied by worsening melasma.

Treatment for melasma

DermaClub recommends combined micropeeling to treat melasma. Combined micropeeling accelerates cell turnover, thereby also speeding up the elimination of the melanin pigment that caused melasma.
The treatment of melasma takes place in the following points:

1. Identification, acceptance and removal of stressors

Triggers of stress are often difficult to completely eliminate. Pharmaceutical products are usually of no help, however it has been observed that when an individual is informed that the melasma is likely caused by stress, they quickly accept this and, in turn, become less worried about the condition, often leading to an improvement in symptoms.

2. Long-term treatment

Long-term treatments are those that do not give immediate results and are often avoided by patients in an attempt to find a quicker solution. However, for melasma there is no alternative, with treatment usually lasting for around one or two years.

3. Adjusting makeup

Many people with melasma use concealer or foundation to mask the spots. However, foundation is poorly tolerated even in healthy skin, as it is very greasy, comedogenic and contains pigments. It is particularly not well tolerated by the skin during micropeeling and hinders the treatment as it slows down desquamation.
Instead, Dermaclub recommends: DermaClub recommends using either: Sun Clay, a mineral, UV-protector compact powder that helps to mask melasma spots, while protecting the skin from the sun’s rays (UV and visible rays) by reflecting them off the face. Argillina Skin Color, a polyglycerol mineral foundation that looks like the traditional product, but with natural components that do not penetrate the skin and that do not inhibit micropeeling.
To remove make-up, avoid cleansers and instead use the delicate, non-foaming Eudermic Cleansing Base.
Micropeeling causes some skin dryness and it is normal to feel skin tightness or slight flaking.
Should this occur, use the self-hydrating Extreme Emollient Ointment in the morning.
Neither Eudermic Cleansing Base nor Extreme Emollient Ointment interfere with micropeeling.

4. Combined micropeeling

Apply seven to ten drops of Glicosal Lotion onto a cotton pad until it is moist. Apply the pad to the face and, from the forehead, pass the pad in a circular motion across the entire face until the pad is dry. Do not rinse and do not apply any other products. Apply Glicosal Lotion six evenings per week. On the seventh evening, swap Glicosal Lotion for Tretinoin solution (trans retinoic acid) which is available from pharmacies with a prescription. Tretinoin accelerates the process of cell renewal and the lightening of melasma, but must only be used once per week as it is particularly powerful and persistent. only be used one evening a week because it is very powerful and persistent in its action. Continue combined micropeeling during the summer months and should only be suspended when all melasma spots have disappeared.

5. Melasma and sun exposure

Despite some believing the contrary, as already mentioned, the sun is not the cause of melasma and, therefore, there is no reason to avoid sun exposure or to use sunscreen with chemical filters, as these can be poorly tolerated by the skin and can worsen melasma. It is important to avoid excessive sun exposure that could trigger redness and exacerbate melasma. Exposure to the sun should be done gradually and individuals should wear a hat with a sun visor and dark glasses. The parts of the face that remain exposed should be covered with Sun Clay, a mineral UV-reflector. Sun Clay should be applied to the skin with the pad and should be topped up throughout the day and/or after swimming.

6. Melasma and the contraceptive pill

Although the contraceptive pill is responsible for many problems in women and should only be used when strictly necessary, there is no data showing it causes melasma.

7. Post-melasma skin

Following the lengthy combined micropeeling treatment and the avoidance of creams and foundations, melasma will clear and the skin will be brighter, finer and more toned.