Melasma occurs as dark macules, similar to freckles. However, with melasma, the dark areas appear as patches as opposed to isolated dots. This condition occurs when there is an increase in melanin below the skin surface.
Melasma commonly coincides with hormone fluctuations, particularly estrogen and progesterone. This is why it often appears during pregnancy and has earned the nickname, “mask of pregnancy.” It also appears in patients who are taking oral contraceptives.
There is usually a genetic predisposition to melasma. This is evidenced through family history and the concurrence of the condition in identical twins.
This predisposition enhances the production of melanin when these individuals are exposed to the sun.
UV rays from sunlight cause a biochemical peroxidation process to occur in lipids, a component of the cell membrane. Essentially, the lipids are oxidized, losing electrons to free radicals. As a defense mechanism, melanocytes (structures within skin cells) react to these changes by producing more melanin, which has been described as the skin’s own natural sunscreen.
The number of melancytes stays relatively constant. However, they are larger than average with a greater number of dendrites.
Melasma is most common in females who represent nearly 90% of all cases. And in women who are predisposed to the condition, it is most likely to occur during their reproductive years.
Instances of melasma are documented in every race. However it is more common in darker skin types, particularly those with light brown skin.
Individuals affected by melasma are encouraged to wear broad spectrum sunscreen that safeguards against both UVA and UVB rays. The recommended SPF is 30+ or higher. This is important for people living in the sunny city of Los Angeles.
Hydroquinone 2-4% is a standard topical treatment for melasma. The common misconception about this active ingredient is that it bleaches the skin. However, it works by reducing the activity level in the melanin production process.
Hydroquinone is an effective intervention for milder forms of melasma that are present only in the epidermis. In most cases, melasma affects not only the epidermis, but the underlying dermal layer as well. Furthermore, this topical treatment requires an extended period of about 3-6 months for results to become evident.
There are many forms of laser systems available. However, only certain wavelengths are ideal for treating melasma. Individual cases will vary. Los Angeles dermatologist, Dr. Umar uses the Fraxel Dual with the 1550nm wavelength and the Nd:YAG Q-switch laser (1064nm) to help clear signs of melasma and other hyperpigmentation issues.
Lasers work by irradiating the skin in a very precise manner to target and eliminate the organelles (within skin cells) containing the melanin, also known as melanosomes. Once these melanosomes are destroyed, the body removes the remains through a sloughing process. Typically there is a brief period where the skin becomes hypopigmented and appears lighter than normal. This is then followed by repigmentation phase where the skin tone is restored.
In June 2013, the FDA approved the Fraxel Dual laser as a treatment for melasma. The energy wavelengths used by this system are safe for all ethnic groups.
Fraxel Dual can be used for other types of pigmentation issues, including age spots which are also caused by the excess secretion of melanin which is triggered by ongoing sun exposure.
Melasma is simply a form of dyschromia and presents no danger whatever to affected individuals. As opposed to just addressing the surface of the skin, It is essential that treatments target the cells and processes that underlie the excessive production of the melanin. Individual presentations will occur with variances that need to be examined by a specialized physician in order to formulate a proper treatment recommendations. If you are in the Los Angeles area and are interested in Melasma treatment options, consult with a board certified dermatologist.
To learn more about the Fraxel laser, click here.