- It is a benign dermatosis that impacts quality of life and whose therapeutic management remains difficult. It is a persistent and recurrent hyperpigmentation whose intensity is fluctuating (the spot is sometimes lighter or darker).
- Melasma begins at puberty or later, with the exception of darker skin types, which tend to develop this problem as early as the first decade of life.
- It affects a majority of young women (9 times out of 10) and is preferentially located on the face. Damage in humans is much less frequent.
- It is most common in darker skin types (Fitzpatrick skin types IV to VI) especially Hispanics/Latinos, Asians, and African Americans.
- More than 1/3 of new melasma appearances occur during pregnancy and 1/4 occur with oral contraceptives.
There are different types of melasma
- Epidermal melasma: affects the superficial layers of the skin. Hyperpigmentation is brown in color with well-defined contours.
- Dermal melasma: affects the deepest level of the dermis and is characterized by blue-gray patches.
- Mixed melasma: (a combination of dermal and epidermal melasma) appears in the form of a greyish-brown pigment.
Clinical forms according to the topography of the hyperpigmentation:
- Centrofacial melasma: It is the most common form with spots, usually symmetrical, located on the forehead, nose, cheeks, upper lip and chin.
- Malar melasma: It appears on the nose and cheeks.
- Mandibular melasma: It forms spots on the ascending branch of the mandible (lower jaw bone).
- Labio-chin melasma with involvement of the upper lip and chin
Causes of melasma
The etiopathogenesis of melasma is complex and multiple.
This is the main factor : UV and visible light. There is a hypersensitivity of the skin’s pigment cells (melanocytes) to light rays, which explains why this dermatosis very 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): estrogen-progestin pills are thought to lead to the production of melanocytes (cells that pigment the skin), which cause the appearance of melasma. It appears in 10 to 25% of women taking oral contraceptives.
Certain hormonal diseases, such as thyroid disorders, can trigger melasma.
Some people are said to have a particular sensitivity to light.
Some chemicals, such as oral or topical treatments, medications, perfumes and essential oils can have a photosensitizing effect when exposed to light.
Daily and repeated microtraumas on the face could have a role in the aggravation and perpetuation of 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 rosacea can stimulate and maintain melasma (nutrient intake).
The efficacy 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 (estrogen), familial and environmental factors (ultraviolet and visible spectrum) that cause an increased and uncontrolled production of pigment in the skin.
How to prevent and avoid the aggravation of melasma?
Sun protection: Sun protection is probably the most important part of the treatment. The slightest exposure to the sun causes the lesions to darken. An hour spent on the terrace of a café without suitable protection leads to the aggravation of melasma for several months.
- In summer, wearing a hat and sunglasses is essential.
- Apply SPF 50+, UVA/UVB sunscreen several times a day, preferably those that contain a blue light filter
Avoid perfumes : favor fragrance-free creams and sunscreens.
Avoid repetitive facial rubbing/rubbing.
Talk to your gynaecologist about changing your pill.
What peeling treatments at the Biolaser center in Mulhouse/Saint-Louis for Melasma?
Dermatological peels improve melasma. The objective of these peels is to promote the penetration of the active agents of the depigmenting peel.
In case of recent or untreated melasma:
Treatment will be more effective if treatment is provided early (less than 2 years after the appearance of the “pregnancy mask”).
The objective of the treatment is not to create inflammation in order to avoid any pigment rebound.
We use superficial peels such as LUMILIGHT OR CRYSTAL PEEL in combination with a depigmenting cream:
LUMILIGHT PEEL is a superficial dermatological peel that accelerates the renewal of the epidermis in order to homogenize pigmentation and reduce pigmentation defects in the skin. It is indicated in the treatment of discoloration: superficial pigmentary disorders, superficial melasma and solar lentigines, inhomogeneity of the complexion.
CRYSTAL PEEL is indicated for the treatment of melasma, solar and senile lentigines, post-inflammatory pigmentation, mild acne and hyperkeraosis. It can be performed up to 3 sessions at 3-week intervals.
In case of old melasma (> 2 years), recurrent, multi-treated or dermal
The treatment is long and the results are difficult to predict because recurrences are common in the case of melasma. We reduce without making the spots disappear but we prevent them from getting worse:
MELA PEEL FORTE is indicated for the treatment of recurrent, multi-treated melasma, post-laser or post-TCA pigmentary rebounds, pigment spots and solar and senile lentigines. For better effectiveness, 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 for up to 2 sessions 30 days apart
In all cases :
- A broad-spectrum SPF 50+ (UVB and UVA, violet and blue protection) sunscreen to apply every morning ALL YEAR
- The doctor prescribes a non-irritating hydroquinone-based depigmenting cream to be applied every evening in preparation (kligman trio) or as a specific cream.
- In the event of redness or associated rosacea, superficial peeling sessions should be alternated with vascular laser sessions that may be associated with tranexamic acid.
- Lasers/IPLs are not a first-line treatment.
