Afraid to leave home because of discolored skin? Dr. Tan explains Melasma treatment

Smooth, acne-free skin is touted as the ideal condition for a beautiful face, but acne is not the only hurdle to overcome to achieve healthy skin. Another sign of unhealthy skin is dark spots and inconsistent skin tone, even if there is no acne or scarring.

Patients who have Melasma have told me they lose confidence and self-esteem due to their discoloured skin. This discolouration occurs when the skin produces too many pigments or melanin. Pigmentation conditions appear in many different forms, such as freckles, sunspots, Hori’s Nevus, post-inflammatory hyperpigmentation, and melasma. Let’s take a closer look at this last one.

What is melasma?

melasma skin

Melasma, also called “chloasma”, is a skin discolouration condition that commonly affects adults. Unlike other pigmentation disorders, melasma is characterized by irregularly shaped patches that appear brown or grey. It is more common for individuals with medium or darker toned skin, or those who tan easily. As a doctor practising in Singapore, I encounter patients with Melasma far more frequently than you would expect.

What parts of the body are affected by melasma?

Melasma affects the parts of the body that are most often exposed to UV radiation from the sun. It often appears on the face, neck, and forearms.

What are the causes of melasma?

The exact cause of melasma is not well understood, but there are many factors that are associated with it and can exacerbate the condition. Most often, melasma is attributed to exposure to UV radiation (sun exposure, phototherapy, sun beds, etc) or hormone imbalances. Certain cosmetics or medications can also appear to cause melasma.

This condition is more common in women than in men, and especially women who are pregnant or taking oral contraception. The hormone changes associated with pregnancy and the pill can cause an over-production of pigments. When pregnant women suffer from melasma it is often referred to as a “pregnancy mask”.

Is melasma contagious or hereditary?

Melasma is neither contagious nor hereditary. However, it can appear in multiple members of the same family who have a history with melasma, though a causal link has not yet been found.

How do I know my condition is melasma instead of some other skin pigmentation disorder?

It’s impossible for me to tell you whether or not you have Melasma or some other condition without me personally examining your skin and knowing all your symptoms. My professional recommendation is, instead of self-diagnosis, to always approach a dermatologist or skincare professional. To get a more accurate diagnosis, your doctor might order some tests to be done, which can involve a biopsy, or taking a small skin sample for further research.

Other tools that a dermatologist might use to diagnose your condition include the Wood’s lamp and the Melasma Area and Severity Index (MASI). These can also be used to determine the extent of melasma once it has been diagnosed.

Is there more than one type of melasma?

There are multiple levels of severity of melasma, and they are separated into dermal, epidermal, and mixed.

The epidermis is the top layer of the skin, so epidermal melasma only affects the very top layer of skin at the surface. The discoloured areas are well defined and thus easy to get rid of. Dermal melasma is harder to treat because it occurs in deeper layers of the skin, where melanin-ingesting cells called melanophages exist. The brown or grey areas of skin are less defined as they stem from deep inside the skin. Mixed melasma refers to the condition of having both dermal and epidermal melasma.

Is melasma a permanent condition?

Whether or not melasma is temporary or permanent depends on the cause of the condition. Melasma triggered by pregnancy or hormone changes can disappear on its own once the hormone balance is restored. Consequently, women who develop melasma during pregnancy should be prepared for it to return if they should get pregnant again.

If the melasma is caused by damage from UV radiation, it is likely that it won’t ever vanish completely. However, there are many ways to treat it and reduce the appearance of the brown or grey patches.

Is melasma preventable?

Sun protection

To prevent melasma, I usually advise my patients to avoid triggers such as excessive sun exposure and hormone changes such as birth control pills and pregnancy. Always wear sunscreen with at least SPF 30 whenever you go outside, and wear wide-brimmed hats or sit under an umbrella if you are going to be in the sun for a long period of time.

What treatments can get rid of melasma?

There are many ways to treat the symptoms of melasma, including:

  1. Cosmetics or skin camouflage. Makeup can be applied to cover up darker patches and make the skin appear more even-toned. Skin camouflage is a thick cream matching a person’s skin tone that is not easily removed once applied. While these solutions do not actually treat melasma or its causes, they diminish the appearance of symptoms and make it easier to live with the condition.
  2. Dermatological procedures. There are several aesthetic procedures that have been advanced in recent years to help restore healthy, beautiful skin. Some of these include:
    • Chemical peels. These procedures involve applying chemicals such as glycolic, lactic, or salicylic acid onto the skin’s surface. This exfoliates the skin and removes the outer layer, so as skin cells regenerate that layer the pigmentation is improved. These should only be done by an experienced medical professional, as the chemicals can be dangerous when used incorrectly.
    • Microneedling. This procedure involves repeatedly inserting very small needles into the skin while applying lightening creams that penetrate into the deeper layers of the skin to lighten pigmentation. 
    • Laser treatments. Lasers are concentrated beams of energy that can be used to destroy dark pigments or to remove the layer of skin affected by the pigments, so the skin cells regenerate without the symptoms of melasma.

Before undergoing any of these treatments, be aware that they often have associated side effects, such as bruising, irritated skin, infections, and swelling. Some of these procedures can also leave scars if done incorrectly.

  1. Topical creams. Treatments such as hydroquinone, retinoid, and steroid creams can be applied topically to the surface of the skin to help eliminate discolouration. Patients using these creams should only do so under the advisement of their doctors, as they can have bad side effects if not used properly. Hydroquinone and retinoid creams are not recommended for pregnant women as they can cause harm to the baby.

What is the best treatment for my melasma?

Melasma before-after treatment

As an aesthetic practitioner who has administered all these treatments before, it is only fair to say they all have their own advantages and disadvantages. Anyone suffering from melasma should consult a dermatologist to determine the best treatment for their individual needs. The best treatment for each person will depend on the type and severity of their condition.

Generally, lasers have the best reputation for fast results, though laser treatment can still take several sessions before showing progress in the most severe cases.

What should I consider when looking for a doctor to treat my melasma?

Always do your research before choosing a doctor to treat you. It’s a good idea to ask around to friends and family for recommendations. Most importantly, make sure your dermatologist is well trained, has the proper credentials, and is experienced in treating melasma and administering specific procedures.