Melasma - Treating Difficult Cases

Melasma is one of the more common conditions seen at Altaire Clinic and is stubborn and still mysterious. Melasma is most common in skin types IV-VI (Asian & Hispanic) and presents as brown patches most commonly to upper lip, chin, forehead and cheeks in a symmetric pattern. Genetics play an important role along with pregnancy (mask of pregnancy), hormone replacement therapy, heat/inflammation, and sun exposure. For some patients, cessation of hormone altering medications and a normal rebalancing of hormones can cause pigments to fade on its own. For others, unfortunately, melasma may persist indefinitely.

There are 3 types (epidermal, dermal, and mixed) with epidermal being easiest to treat. There have been many studies suggesting the combination of topical treatments and professional skilled lasers are the best way to treat melasma.

Here at Altaire, treatment for melasma is addressed in a combination approach. Medical grade topicals can suppress excess melanin through multiple mechanisms of action. The addition of lasers help to deliver faster, more beneficial treatment outcomes. Altaire recommends both the Halo™ and Focus lasers to ablate and disrupt the heavy concentration of both superficial (epidermal) and deep (dermal) dark brown areas of hyperpigmentation.

Other options for treatment of melasma:

• Hydroquinone (prescription) inhibits copper from binding with tyrosinase and induces melanocyte specific cytotoxicity (destruction).
• Retinoids (prescription) or in non-prescriptive form of Nouvelle 0.6% or Pro-Heal to suppress the activity of tyrosinase, decrease quantity and inhibit melanosome transfer. Not only are retinoids melanocyte inhibitors, but they also boost pigment cell turnover.
• Vitamin C (ascorbic acid), Pro-heal/Super serum 15%, MicroNight & MicroDay to convert dopaquinone back, for prevention of melanin from forming.
• Oral and topical antioxidants in preventing inflammation of the skin to prevent excess melanin formation.
• A broad-spectrum Sunblock with minimum of SPF 30 (MicroDay, Extreme protect, Eclipse SPF 50) is needed with added thymine pigment inhibitors, antioxidants and anti-inflammatories.
• Focus on gentle skin care using non-detergent cleansers and Clairsonic brush.

Although, frustrating for both patients and skin health professionals, melasma can be successfully treated. It is important to note that patients prone to hyperpigmentation and melasma will always be susceptible to recurrence. Most patients end up on a continuous regimen of product containing melanogenesis-suppressing ingredients and lasers.