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Melasma is a common skin condition represented by brown and black patches over the cheeks, nose, and forehead. Mostly seen in women of the childbearing age, it has become increasingly common in males as well. It has been widely recognized as one of the most common reasons for facial pigmentation.
Melasma is a multifactorial skin condition. The most common and well-known cause of melasma is excessive sun exposure. The genetic predisposition of the individual and the family history of melasma are also very common causes for developing this skin condition. Thyroid disease, pregnancy and hormonal imbalances, including intake of oral contraceptive pills are known to worsen melasma. Stress, smoking, and exposure to heat also increase melasma.
The pigment in the melasma is derived from the patient's own melanocytes. This process is triggered by the above reasons. Melasma cannot be cured completely as the formation of melasma is a continuous process, however, it can be regulated. So, the treatment has to be continued for the long term, as it cannot interrupt the process, but only hasten the removal of the pigmentation.
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As we know that melasma is multifactorial, it is important to control the factors that trigger its production. Application of a broad spectrum sunscreen regularly as well as avoiding sun exposure during peak hours is an important part of preventing recurrence of melasma. Avoiding smoking, and, eating bright colored fruits and vegetables helps to regulate the formation of melasma.
Melasma is a chronic skin condition, and the treatment is a combination of home care and clinic-based therapies. The backbone of the treatment is a broadspectrum sunscreen, topical skin lightening agents, and oral antioxidants. In addition, lifestyle modifications, reducing sun exposure during peak hours, and avoiding smoking can also help to prevent exacerbation of melasma. Dietary inclusions of bright colored fruits and vegetables, oral vitamin C, and antioxidant supplements help to reduce pigmentation.
Chemical peels work by removing the excess pigment and can be easily combined with the home care regimen. Treatments such as Dermaroller and PRP also provide optimal results in eliminating melasma when released into the skin through Mesotherapy, is also an effective option for treating melasma.
The pathology in melasma is the increased formation of melanin by melanocytes which is then, transferred to the epidermal keratinocyte cells. Chemical peels work by removing the excess pigmentation by exfoliating the outer layers of the skin that helps to lighten the pigment load, and also allows easy penetration of the skin lightening creams into the melanocytes. However, care must be taken to ensure optimum sun protection to prevent any damage to the newly regenerated skin, and also to avoid the recurrence of melasma.
Lasers such as the fractional carbon dioxide laser and the Q YAG lasers have been promising in the treatment of melasma in many international studies. However, in darker skin tones, these laser results can be often unpredictable and may result in pigmentation or worsening of melasma. The laser should be used with great caution and should be considered only when the other treatments fail.
Dr. Rasya Dixit, Medical Director, is a trusted clinical and cosmetic dermatologist from Bangalore, with more than 10 years of experience and expertise in her field.
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