This condition does not present any risk to health, however, because it causes aesthetic discomfort, it is a frequent complaint among dermatologists.
Types of melasma
Melasma can be classified according to two factors: the location of the melanin deposit and the location of the spots. Understand:
As stated earlier, the overproduction of melanin causes the accumulation of melanin, which is lodged somewhere within the skin. Thus, the spots can be:
- Epidermal Melasma: When melanin is deposited in the epidermis, the most superficial layer of the skin. It is, consequently, the easiest to treat melasma;
- Dermal Melasma: When the pigment deposit is in the dermis, the innermost layer of the skin, it can be next to blood vessels, nerves and other anatomical structures. For this reason, it has difficult treatment;
- Mixed melasma: It occurs when the pigment deposit occurs in both the dermis and the epidermis, being possible a higher concentration of melanin in one of the two layers.
Melasma can also be classified according to its place of appearance:
- Facial pattern: Occurs on the face, in any location;
- Malar: Presents on the cheekbones;
- Centrofacial: Present on the forehead, cheeks, above the lips (jaw), nose and chin;
- Mandibular: Occurs in the lower portion of the face, below the lips, a region called the mandible;
- Corporal: Presents in any part of the body, as in the arms, lap, shoulders and back.
Causes and risk factors
There is no knowledge about the true cause of melasma. It is only known that it appears due to the high amount of melanocytes in the skin, and that the main triggers are the sun and the heat. Hormones also seem to play an important role in the development of melasma. Understand:
Sun, light and heat
Ultraviolet and infrared radiation appear to be related to an increase in the amount of active melanocytes in the skin. These radiations come from the sun and other sources of heat, as well as light sources. That is, even the lamps indoors and heat (fog) can help in the development of melasma.
One of the main suspected causes of melasma is hormonal changes in women of reproductive age, who use oral contraceptives, pregnant women and menopausal women. That’s because, when estrogen levels are high, melanin production is increased.
According to Dr. João Carlos Pereira, the technician responsible for the Derm portal , estrogen seems to be the key element for the appearance of spots, the sun and heat being only catalysts.
When melasma occurs during pregnancy, it may be called chloasma gravidarum .
Pollution in large cities brings harm to the skin in general, but studies analyze the possibility that it may also be a triggering factor for melasma. That’s because, in an article published in 2010 in the Journal of Investigative Dermatology , it was found that women living in urban centers in Germany had more hyperpigmentation than those living in the countryside.
It has been proven that pollution helps in the premature aging of the skin, in addition to leaving it more debilitated and dehydrated, which can contribute to a greater risk of any skin problem.
Current studies, such as those mentioned in the chapter Disorders of Pigmentation , published in the book Skin of Color , in 2013, consider a genetic tendency in the formation of melasma. In addition, ethnic characteristics can also play an important role in this condition.
Groups of risk
In general, melasma happens more easily in:
- Women of reproductive age;
- Users of oral contraceptives;
- Pregnant women;
- Residents of cities with hot climate.
Symptoms of melasma
In general, the only symptom of melasma is the appearance of brown spots on the skin. There is no itching, burning or pain.
The spots usually appear on the cheekbones, forehead, nose, upper lip (jaw) and temples. They have an irregular shape and often have a pigmented speckled border. They can increase and decrease in size and intensity, according to the coexistence with triggering factors.
When experiencing any discomfort such as burning, itching and pain, you should consult a dermatologist as soon as possible.
How is the diagnosis of melasma made?
When consulting a dermatologist with complaints of skin blemishes, the doctor can evaluate the blemish with an instrument called Wood’s lamp, a fluorescent lamp capable of detecting dyschromias (color changes) in the skin.
The light irradiation penetrates deeply into the skin and is absorbed by the melanin granules at the levels at which they are found. Thus, it is possible to determine whether the melasma is dermal or epidermal, since the dermal patches are blackened in that light, while the epidermal patches do not appear so clearly.
Does Melasma have a cure? What is the treatment?
Unfortunately, melasma has no cure . Therefore, the treatment is aimed at the control and prevention of new spots. Care must be continuous, as it is a chronic condition that tends to worsen if left unattended.
Treatment can be done in 4 ways:
- Prevention of new stains;
- Treatment with whitening creams;
- Laser treatment.
Prevention of new stains
The main way to prevent new stains is to avoid the sun and heat. If this is not possible, you should always be protected from ultraviolet and infrared rays. Therefore, it is recommended to use sunscreen daily .
The dermatologist can recommend a sunscreen with a filter that best suits the patient’s skin. Factors that influence the doctor’s choice are ethnicity and skin type (dry, oily, etc.), as different skins have different needs.
In general, the indicated sunscreen has high protection against UVB (SPF) and UVA (PPD) rays , and must be reapplied several times a day (every 2 or 3 hours). Formulas can also contain whitening and antioxidant actives, which help maintain skin health.
Some commonly indicated protectors are:
- Anthelios XL La Roche-Posay ;
- Idéal Soleil Clarify Vichy ;
- Neutrogena Sun Fresh Facial .
Not all sunscreens can be used by pregnant women. Always consult your dermatologist and obstetrician to be sure which products are released for use, as products that are not recommended can cause damage to pregnancy.
Treatment with whitening creams
Although there is no way to get rid of stains completely, whitening creams help to disguise a little. This means that the stain will not disappear completely, but it is more “erased” on the face, bringing more uniformity to the skin.
The results start to appear after 2 or 3 months of treatment and are not always satisfactory. Improvement is slow and gradual, that is, it takes patience to generate results.
Factors that influence the effectiveness of treatment with creams are the time of existence of melasma, previous unsuccessful treatments, depth of the stain and time of sun exposure.
The most used creams are those that have hydroquinone, retinoic acid (tretinoin), kojic acid, glycolic acid, azelaic acid, arbutin, among others, as active ingredients. Some examples of creams that the dermatologist may recommend are:
- Pigmentclar Serum La Roche-Posay ;
- Skinceuticals Discoloration Defense Serum ;
- Kiaritá TheraSkin ;
- Ada Tina Dual Clear Night.
In some cases, the doctor may also indicate a prescription that must be sent to a handling pharmacy. This manipulated cream is required when the doctor believes that the options on the market are not suitable for the patient.
Never use dermocosmetics without first consulting your dermatologist, as he is the professional who can indicate the most appropriate treatment.
Peeling is a type of semi-invasive treatment, in which the damaged layers of the epidermis are eliminated through the use of acids. This removal stimulates cell renewal, improves texture and local circulation, lightens the spots and also attenuates fine wrinkles. In addition, it also stimulates the production of collagen, the main protein for skin firmness.
Serial peels can bring good results for melasma, but do not dispense the treatment with whitening creams, which must be continuous, according to what is recommended by the dermatologist.
Other types of peeling and similar techniques can also bring benefits, such as physical peeling and dermabrasion. It is good to remember that superficial peels are safer than deeper peels. Therefore, the results are better in epidermal melasmas.
The procedure should only be performed by a qualified professional, such as a dermatologist or beautician. Avoid using homemade peeling techniques, as there is no proof of their effectiveness and even safety, and may, instead of improving, worsen the skin’s health.
Ultimately, when none of the above works to improve the appearance of melasma, the dermatologist may recommend laser treatment. This is the technique that gives the best results, but also the most complicated to perform. Therefore, it is necessary to have a good professional who knows how to choose the most appropriate treatment for the patient.
The types of laser most used in this treatment currently do not:
- Intense Pulsed Light (IPL / LIP): This technique consists of the application of an intense and fast flash of light, which is absorbed by the skin. Because it works in several different wavelengths, it is absorbed by several different pigments. It significantly reduces blemishes and stimulates collagen production, but it can cause a rebound effect.
- Fractional CO2 laser: Widely used to improve the appearance of scars, this technique promotes the vaporization of water from the skin, which heats up quickly and helps in the reorganization of tissue. Because it is more aggressive and causes heat, it can also make melasma worse.
- Laser Nd-YAG QS (Laser Spectra, Elektra, Vektra QS): It is considered the best technique for treating melasma today, as it has high affinity with melanin and does not heat the skin. It does not cause a rebound effect and can be done at any time of the year.
Even laser treatment does not dispense with continuous treatment with creams. In addition, it is necessary to follow up with the dermatologist, as it is not a definitive treatment.
If, after the laser treatment, the patient perceives the skin to be very irritated, darker or has some other problem, he should contact the dermatologist as soon as possible.
What to expect from treatment for melasma?
When performing treatment for melasma, you must be realistic: the condition is chronic and can show periods of improvement and worsening. The person with melasma must also be patient, since the treatment is slow and takes time to show results. Therefore, it is necessary to focus on the possibility of improvement, instead of longing for the total elimination of stains.
Care must be taken with people (websites, companies, among others) who offer miraculous solutions that do not present risks. Often, these “solutions” do not work, have not been scientifically proven, and the potential for harm they can cause is unknown.
Because it is a chronic condition, melasma is something that the patient must live with for the rest of his life. Therefore, she must take all necessary measures to prevent the appearance of new spots, as well as treat existing spots according to the dermatologist’s recommendations.
Some tips for living with melasma are:
- Always use sunscreen, even on cloudy days and when staying at home all day, as artificial light also has an influence on melasma;
- Using physical (inorganic) sunscreens can be more effective than chemical filters. Physical filters are those that have zinc oxide and titanium dioxide;
- Maintaining treatment and follow-up with the dermatologist is extremely important for the effective control of melasma;
- Avoiding spending the summer holidays in places with a lot of sun and fog, such as the beach, can help to keep the stains under control;
- Patients who suffer emotional consequences due to melasma, such as low self-esteem, should seek psychological help;
- Women of reproductive age who use hormonal contraceptives should look for another method of contraception, preferably without the involvement of hormones;
- For some people, the use of antioxidant supplements can help to mitigate the damage caused by solar radiation. Talking to a nutritionist about the possibility of using these supplements is a good idea.
Melasma itself does not cause more serious complications for the patient’s health. What happens, many times, is a worsening in mental health , due to the aesthetic discomfort caused by the disease.
Therefore, having melasma can trigger problems of low self-esteem , depression , anxiety and other mental disorders. A study published in the Journal of Dermatological Treatment reveals that many Hispanic women felt negative emotions about their condition, but did not share it with anyone. Some people even avoided people and situations in which the spots could be exposed.
It is extremely important that patients with emotional problems due to melasma seek psychological or psychiatric help, to avoid further complications.
How to prevent melasma?
Preventing melasma can be difficult, as many are unaware that they have a predisposition to develop the condition and only discover it after the spots appear. However, melasma prevention measures are also preventive measures for melanoma (skin cancer), and should be taken by everyone, regardless of genetic predisposition.
Some tips to prevent are:
- Use sunscreen every day, regardless of the weather;
- Women of childbearing potential should opt for non-hormonal contraceptive methods;
- Menopausal women should avoid hormone replacement therapies;
- Adequate food rich in antioxidant foods helps prevent various diseases, including improving the skin’s natural protection against the sun’s rays;
- You should always remove makeup before bed. Although there is no evidence that makeup, in itself, can contribute to the appearance of melasma, the proper removal of debris before bedtime prevents premature aging and other skin problems;
- Keep away from heat sources such as barbecues, stoves, saunas, cars exposed to the sun, among others, to avoid stimulation of melanin production;
- Use physical protections, such as hats and parasols;
- When you notice a first spot, you should go to the dermatologist as soon as possible, to investigate and define a treatment.