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O melasma! Why are thou treatment so difficult?

What is melasma?

“Melasma is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation. Melasma can also affect the arms and back. It can lead to considerable embarrassment and distress.” – DermNetNZ

Melasma 1

What causes melasma?

The cause for this is complicated. The pigment we see in the skin is an overproduction of melanin produced by melanocytes, taken up by keratinocytes and deposited in dermis/epidermis. The whole system of melanin production/deposit of pigment has essentially gone haywire in melasma.

Sometimes, it is very difficult to identify triggers as there may be a genetic component to melasma. Some identifiable triggers can be:

  • hormones (oral contraceptive pill)
  • pregnancy
  • thyroid disorders
  • sun exposure
  • Irritants to the skin (cosmetics, peels, ?Blue light, ?excessive heat)

Treatment involves usually avoiding triggers and also using a combination of treatments. Most people have mixed melasma that is pigment and is both in epidermal and dermal level. This can be tackled with:

  • Lifelong sunscreen and sun protection
  • good and gentle home care routine with ingredients that work in pigment level with ingredence such as locorice extract, kojic acid, vitamin c etc. eg the Mela Cream  by Dermaceutic
  • Q switch laser
  • Chemical peels designed for treatment of melasma
  • Prescription compounded medication cream eg Kligman’s
  • oral medication eg tranexamic acid.

Why is melanoma difficult to treat?

In most patients Melasma is a chronic condition and one method does not generally work. As it is difficult to manage due to its various triggers and limited treatment options, the aim of treatment is to stabilise and maintain control.

Melasma 2