- It is a benign dermatosis that affects quality of life and is difficult to treat. It is a persistent and recurrent hyperpigmentation whose intensity fluctuates (the spot is lighter or darker at times).
- Melasma begins at puberty or later, with the exception of darker skin types, which tend to develop this problem in the first decade of life.
- It affects a majority of young women (9 times out of 10) and is located preferentially on the face. It is much less common in men.
- It is more common in darker skin types (Fitzpatrick skin types IV to VI), particularly Hispanics/Latinos, Asians and African-Americans.
- More than 1/3 of new cases of melasma occur during pregnancy, and 1/4 occur while taking oral contraceptives.
There are different types of melasma
- Epidermal melasma : affects the superficial layers of the skin. The hyperpigmentation is brown in colour with well-defined contours.
- Dermal melasma : affects the deepest level of the dermis and is characterised by blue-grey patches.
- Mixed melasma : (a combination of dermal and epidermal melasma) appears as brown-grey pigment.
Clinical forms according to the topography of the hyperpigmentation :
- Centrofacial melasma : This is the most common form, with spots, generally symmetrical, located on the forehead, nose, cheeks, upper lip and chin.
- Malar melasma : Appears on the nose and cheeks.
- Mandibular melasma : This forms spots on the rising branch of the mandible (lower jaw bone).
- Melasma labiomentum with involvement of the upper lip and chin.
Causes of melasma
The aetiopathogenesis of melasma is complex and multifaceted.
In summary, melasma is the result of an interaction between hormonal factors (oestrogens), family factors and environmental factors (ultraviolet and visible spectrum) that cause increased and anarchic production of pigment in the skin.
The main factor is UV and visible light. The skin’s pigment cells (melanocytes) are hypersensitive to light rays, which explains why this dermatosis often worsens in spring and summer.
Estrogen receptors have been found on melanocytes (pigmentation cells) in melasma lesions:
- During pregnancy, hormonal changes make the skin much more photosensitive, which stimulates the production of pigment on the epidermis. It is called a pregnancy mask when it appears during pregnancy.
- Taking oral contraceptives or hormone replacement therapy (HRT): oestroprogestogenic pills are thought to lead to the production of melanocytes (cells that pigment the skin), which are responsible for the appearance of melasma. Melasma occurs in 10-25% of women taking oral contraceptives.
Certain hormonal diseases, such as thyroid disorders, can trigger melasma.
Some people are particularly sensitive to light.
Certain chemical substances, such as oral or topical treatments, medicines, perfumes and essential oils can have a photosensitising effect when exposed to light.
Daily and repeated microtrauma to the face could play a role in aggravating and perpetuating melasma lesions. The topography of melasma corresponds to the bony reliefs subjected to friction during washing and during instinctive gestures, make-up and make-up removal.
- Certain associated pathologies such as couperose can stimulate and maintain melasma (nutrient inputs).
- The efficacý of tranexamic acid, a plasminogen inhibitor, and the pulsed dye laser targeting mainly the vascular components of the skin further support the vascular theory of melasma.
- In summary, melasma is the result of an interaction between hormonal factors (estrogens), familial factors, and environmental factors (ultraviolet and visible spectrum) that lead to increased and unregulated pigment production in the skin.
How can I prevent melasma from getting worse?
Sun protection : sun protection is undoubtedly the most important part of the treatment. The slightest exposure to the sun causes lesions to darken. An hour spent on a café terrace without appropriate protection will cause melasma to worsen for several months.
- In summer, wearing a hat and sunglasses is essential.
- Apply a UVA/UVB SPF 50+ sun cream several times a day, giving preference to those containing a blue light filter.
Avoid fragrances: use fragrance-free creams and sunscreens.
Avoid repetitive rubbing of the face.
Discuss the possibility of changing pills with your gynaecologist.
What peeling treatments are available for Melasma at the Biolaser center in Basel/Saint-Louis ?
Dermatological peels improve melasma. The aim of these peels is to promote the penetration of the active agents in the depigmenting peel.
In cases of recent or never-treated melasma:
Treatment will be more effective if it is started early (less than 2 years after the appearance of the “pregnancy mask”).
The aim of the treatment is to avoid creating inflammation so as to prevent any pigmentary rebound.
We use superficial peels such as LUMILIGHT or CRYSTAL PEEL in combination with a depigmenting cream:
LUMILIGHT PEEL is a dermatological superficial peel that accelerates the renewal of the epidermis in order to homogenise pigmentation and reduce pigmentation defects in the skin. It is indicated for the treatment of dyschromias: superficial pigmentary disorders, superficial melasma and solar lentigos, and uneven skin tone.
CRYSTAL PEEL is indicated for the treatment of melasma, solar and senile lentigos, post-inflammatory pigmentation, mild acne and hyperkeratosis. Up to 3 sessions can be carried out at 3-week intervals.
In cases of long-standing (> 2 years), recurrent, multi-treatment or dermal melasma
Treatment is long and results are difficult to predict, as recurrences are common in melasma. The spots are reduced without disappearing, but their worsening is prevented:
MELA PEEL FORTE is indicated for the treatment of recurrent, multi-treatment melasma, post-laser or post-TCA pigmentary rebound, pigmentation spots and solar and senile lentigos. For greater efficacy, certain concentrations of depigmenting and keratolytic active ingredients have been increased, so it will be reserved for phototypes I to IV.
MELA PEEL FORTE can be repeated up to 2 times, 30 days apart.
In all cases :
- Sun protection and a high SPF 50+ broad-spectrum sunscreen (anti-UVB and UVA, anti-violet and anti-blue) to be applied every morning ALL year round.
- The doctor will prescribe a non-irritating hydroquinone-based depigmenting cream to be applied every evening as a preparation (kligman trio) or as a specific cream.
- In the event of associated redness or blotchiness, superficial peeling sessions are alternated with vascular laser sessions, which may be combined with tranexamic acid.
- Lasers/IPL are not a first-line treatment.
