Melasma: Causes, forecast and symptoms

Published At: 09 January 2020 , 06:21 PM

Melasma: melasma - a violation of pigmentation of the skin of the face with an increase in the formation of melanin and most often localized in the upper cheeks, nose, on the forehead, upper lip. May occur in 50% of women during pregnancy.

Melasma is more likely to affect women than men; it appears between the ages of 30-40. Individuals with darker skin or a good reaction to the sun (who tan well) have a greater tendency. Most often localized in the upper part of the cheeks, nose, on the forehead, upper lip; may occur in 50% of women during pregnancy. Melasma darkens under the sun's rays or any other sources of ultraviolet radiation - tanning beds.

Melasma is also known as the "mask of pregnancy" - chloasma.

With melasma, unlike chloasma, age spots can appear in people at any age, regardless of gender. The pigment spots resulting from solar irradiation are the astral form (Melasma solar), with liver pathologies, the liver form of melasma (Melasma hepatica), which differs from the others in the localization of pigment spots mainly on the lateral surfaces of the neck, the absence of clear boundaries and often with a network of telangiectasias. See the laser removal of blood vessels in detail.

Melasma tends to change pigmentation saturation throughout the year. During increased sun activity, age spots have a more saturated shade and precise contours, compared with areas of the skin that are not affected by melasma. In the autumn-winter period, the influence of ultraviolet radiation of sunlight is not so pronounced. Therefore, age spots become pale, less noticeable, do not have such a clear border between the skin areas not affected by melasma.

Causes

A leading role in the development of melasma given to a genetic predisposition.

The trigger factor may be:

Pregnancy - often pathology regresses within a few months after childbirth

Hormonal contraceptives can also cause melasma, but hormonal therapy during menopause does not lead to the appearance of melasma.

An extended stay in the sun or the solarium

Cosmetics containing photosensitizers

Forecast

Reverse regression of melasma is possible a few months after the birth or termination of breastfeeding. The problem of melasma is that it can be treated quite slowly and requires prolonged qualified medical supervision.

Treatment

It is necessary to use sunscreens with a wide range of protection. Optimal use of SPF 30 and above. Sunscreen should be applied daily, regardless of whether a person goes out or not. It is also well treated with bleaching creams or prescription drugs.

Melasma The main approaches to treatment.

The abolition of hormonal contraceptives, if a woman takes them, is an essential point in the treatment of melasma.

Avoid taking medications, food additives, and foods with a photosensitizing effect.

Application of sunscreens all year round. Sunscreens should have a wide range of protection - UVB + UVA.

Do not use powerful skin cleansers (often used to treat and prevent acne).

Use caution when applying cosmetics containing retinoids, α-hydroxy acids, β-hydroxy acids (AHA, BHA). Specialist consultation required.

Avoid overdrying the skin, as the skin produces its own SPF.

The use of cosmetics that inhibit melanogenesis:

Lumixyl-decapeptide-12 inhibiting tyrosinase

hydroquinone (use prohibited in Europe, contraindicated during pregnancy and lactation)

koic acid

azelaic acid (may be used during pregnancy)

Topical corticosteroids - give a relatively quick clinical effect, especially in cases where the appearance of melasma is associated with inflammatory phenomena in the skin.

Exfoliating techniques:

SilkPeel with Lumixyl Proinfusion

Chemical peels (should be carried out only by a doctor, since it is necessary to observe a specific rehabilitation regimen):

      1. Salicylic acid.
      2. Hydroxy acids - glycolic, lactic, etc.
    1. Topical retinoids are tretinoin. Contraindicated during pregnancy.
    2. Microdermabrasion. The disadvantage is the uneven effect in depth. Preferred laser peels with adjustable depth - SilkPeel.
    3. Laser peelings - preference should be given to "cold lasers" - erbium lasers (Er: YAG 2940nm). MicroLaserPeel Procedure. A sound effect will be achieved with the epidermal type of melasma. Lasers with pronounced coagulation (warming up), such as a CO2 laser, non-ablative fractional lasers, often themselves cause hyperpigmentation. This is one of the possible side effects.
    4. Fractional rejuvenation. If the pathology has dermal localization, the best results will be achieved by fractional skin rejuvenation with a ProFractional erbium laser (Er: YAG 2940nm), since fractional destruction of deep-lying pigment, in this case, is possible and, secondly, treatment will be combined with microgeneration - the formation of microchannels, through which the dye will be easily removed from the deep layers (dermis, papillary layer).
    5. If the pathology is of a mixed type, then the best results will be shown by a combination of surface erbium laser peeling with fractional rejuvenation with an erbium laser. Or a combination of BBL photorejuvenation with fractional erbium skin rejuvenation.
    6. New - the HALO laser - the first hybrid fractional laser allows you to act on different levels of pigment occurrence in a single procedure - on dermal, deep-lying pigment and epidermal, surface pigment.

Techniques that destroy pigment - BBL photorejuvenation. These methods are by far the best choice for the correction of pigmented formations, as it allows you to destroy the pigment without violating the integrity of the skin. The disadvantage is the difficulty of removing deep-lying pigment spots (dermal form).

Oral administration of proanthocyanidins. Proanthocyanidins (proanthocyanidin, procyanidins) are a natural component and can achieve excellent results, both in monotherapy and in combination with other treatment methods. Will be indispensable in case of intolerance to other drugs.

The effect of treating melasma achieved slowly. Complete elimination of melasma can be achieved only in 30% of cases. In other cases, a stable remission achieved, but upon contact with the sun or with a change in the hormonal background, symptoms may regress.