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Melasma is an irregular, brown or brown-gray facial hyperpigmentation also known as “chloasma”. Dark skin spots gradually appear on the cheeks, forehead, nose and upper lip, but also in other areas. This condition is more common in women and is often associated with pregnancy and medication containing hormones.

Melasma is divided into three types: epidermal, dermal and mixed. Epidermal melasma is the most superficial and is characterized by increased skin pigmentation in the top layer of the skin. Dermal melasma is defined by increased skin pigmentation in the second layer of the skin. Finally, mixed melasma is a combination of epidermal and dermal melasma.

Risk factors for melasma

There are many factors that contribute to this disease: genetic and ethnic predisposition on dark skins in general; pregnancy; and specific medication such as anti-epileptic drugs, antidepressants or hormone replacement therapy; in all cases, exposure to ultraviolet rays is always the trigger.

Stress is produced by the adrenal glands from the same basic material as progesterone. Therefore, if this material is regularly converted to cortisol, it will affect your progesterone level. Progesterone balances estrogen, since these two hormones work together. As a result, stress contributes to higher estrogen levels, which causes hyperpigmentation. Nutritional deficiencies and a weak liver can lead to melasma because the hormones are not processed properly.

Treatments for melasma

The best treatment is still preventive: strict sun protection and sunscreen. Strong sources of estrogen should also be avoided; the contraceptive pill, hormone replacement therapy during menopause and endocrine disruptors are among these.

Although hormonal balance (and estrogen dominance) does not depend only on diet, it is essential to start by choosing foods that improve liver function and encourage proper thyroid function, as well as foods rich in zinc. It is possible to reinforce the work of these foods with certain food supplements.

Aesthetic medicine and melasma

To treat melasma, a combination of topical products, a peel and laser is required, if need be.

Topical creams should stop melanogenesis or melanin synthesis by blocking the activity of those cells responsible for producing melanin (melanocytes). These include depigmenting creams (containing hydroquinone, tranexamic acid, etc.), creams formulated using fruit acids to exfoliate the superficial layers of the skin (azelaic acid, glycolic acid), creams containing retinoids and, lastly, steroid creams. For stubborn cases, the three active ingredients can be combined (triple therapy or Kligman’s formula).

It is also crucial to protect oneself effectively and lastingly from UV rays with SPF 50+ sunscreen.

A depigmenting peel is also a precious ally. It is a medium depth peel that reaches the superficial part of the middle dermis. It will require 3 sessions spaced 4 to 6 weeks apart. The result is gradual. The skin must be prepared well beforehand, and proper observance and sunscreen are necessary. Care should be taken with melasma on darker skin types – light peels should be used to avoid rebound pigmentation.

Finally, laser or intense pulsed light are very good solutions for epidermal melasma alone. However, they may aggravate deep dermal melasma.

The laser and the pulsed light will destroy the melanocytes (cells which produce melanin) by photo-thermolysis. This allows the spots to gradually fade. At least 3 sessions spaced 6 weeks apart will be required.

Important precautions before any laser session:

  • Prepare your skin well for 1 month with depigmenting creams
  • Skin should not be tanned.

As the skin’s reaction to the laser is inflammatory, it is also important not to expose your skin to the sun in the weeks following the treatment to avoid post-inflammatory hyperpigmentation.

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