Melasma is a common skin pigmentation condition that appears as brown to gray patches typically on the cheeks, forehead, nose and chin. It occurs predominantly in females with only 10% of males having this condition.
Melasma, also known as chloasma, is common in females after pregnancy giving rise to the term “mask of pregnancy".
The causes are multifactorial and include sun damage, hormonal factors, inflammatory (increased mast cell activity), increased vascularity and disruption of the basement membrane and skin barrier function.
Treatment nowadays are multimodal and include laser toning (various modalities of pigment lasers including the PicoSecond lasers), laser to reduce vascularity (vascular lasers like Dual Yellow, ExcelV and Clarity2), reducing inflammation and restoration of basement membrane integrity (pulsed RF device like Slyfirm).
It is also important to determine the skin type of the patient before deciding on the choice of laser. The use of Tranexamic acid either in oral or topical forms is also widely used.
Of course, sun protection and topical lightening agents (with or without hydroquinone) and topical vitamin C 10% and adequate moisturisation are required.
A newer form of topical product on the market now is Cysteamine cream which apparently has equivalent potency to hydroquinone but lesser side effects.
It is important to seek the opinion of a doctor experienced in the treatment of Melasma who is able to offer a multimodal approach as the condition if inappropriately treated can become worse.
Hope this helps!
Regards
Dr KK Chew
