Understanding Melasma
Melasma is a common acquired pigmentation condition characterised by irregular brown or grey-brown patches, most frequently appearing on the cheeks, forehead, upper lip and chin. It can affect people of all skin types and is more commonly observed in women, particularly during their reproductive years (Espósito et al., 2022; Artzi et al., 2021).
Although melasma is not generally considered a harmful skin condition, its persistent and recurring nature can affect skin confidence and quality of life.
What is melasma and what causes it?
Melasma develops when melanocytes, the specialised cells responsible for producing melanin, become overactive and increase pigment production in particular areas of the skin.
Its development is multifactorial, involving an interaction between genetic susceptibility, hormonal influences, inflammation and environmental exposure (Artzi et al., 2021; Espósito et al., 2022).
Common contributing factors include:
Hormonal influences: Pregnancy and hormonal changes, including those associated with hormonal contraception, may contribute to melasma.
Sun exposure: Ultraviolet radiation is a significant trigger and can worsen existing pigmentation.
Visible light: Research indicates that visible light, particularly high-energy visible light, can contribute to pigmentation, especially in darker skin phototypes.
Genetic predisposition: Family history and individual skin characteristics can influence susceptibility.
Inflammation: Irritation and inflammation may contribute to pigment changes and can complicate the management of melasma.
Melasma is not simply a surface-level pigmentation concern. Research has identified changes involving multiple skin structures, including the epidermis, basement membrane and upper dermis, which help explain why it can be persistent and difficult to manage (Espósito et al., 2022).e.
Home skincare and pigmentation management
A consistent home-care routine is an important part of managing pigmentation.
Depending on individual skin needs, skincare ingredients may be selected to support the skin barrier, minimise irritation and address uneven skin tone.
Professional guidance is particularly important for melasma because certain active ingredients and aggressive treatments may cause irritation and potentially worsen pigmentation.
What does managing melasma involve?
Melasma is a chronic, recurrent condition, meaning that ongoing management is often necessary. There is no single treatment that guarantees permanent clearance (Espósito et al., 2022).
An individualised management approach may involve:
Assessment of skin characteristics and contributing factors.
Appropriate home skincare.
Consistent broad-spectrum sun protection.
Consideration of visible-light protection, including tinted sunscreens containing iron oxides.
Medical assessment where hormonal, medication-related or other contributing factors require investigation.
Referral to a dermatologist or medical practitioner when appropriate.
Research identifies photoprotection as one of the most important components of melasma management. Both ultraviolet radiation and visible light can contribute to the development and recurrence of pigmentation (Morgado-Carrasco et al., 2022).
Professional treatments, including selected chemical peels, may be considered in some cases. However, treatment selection requires care, as excessive inflammation or irritation can worsen pigmentation, particularly in individuals with darker skin phototypes (Espósito et al., 2022).
A personalised approach to skin health
Melasma can be persistent and requires a considered approach. Understanding the contributing factors, maintaining appropriate skincare and protecting the skin from environmental exposure are important parts of long-term management.
At Society Cosmetic and Skin Clinic, we believe in taking the time to understand your skin and discussing suitable options based on your individual needs.
Book a skin consultation with our Registered Nurse to discuss your skin concerns and explore appropriate skincare options.
References
Artzi, O., Horovitz, T., Bar-Ilan, E., Shehadeh, W., Koren, A., Zusmanovitch, L., et al. (2021). The pathogenesis of melasma and implications for treatment. Journal of Cosmetic Dermatology, 20(11), 3432–3445.
Espósito, A. C. C., Cassiano, D. P., da Silva, C. N., Lima, P. B., Dias, J. A. F., Hassun, K., Bagatin, E., Miot, L. D. B., & Miot, H. A. (2022). Update on melasma—Part I: Pathogenesis. Dermatology and Therapy, 12, 1967–1988.
Morgado-Carrasco, D., Piquero-Casals, J., Granger, C., Trullàs, C., & Passeron, T. (2022). Melasma: The need for tailored photoprotection to improve clinical outcomes. Photodermatology, Photoimmunology & Photomedicine, 38(6), 515–521.
Espósito, A. C. C., et al. (2022). Update on melasma—Part II: Treatment. Dermatology and Therapy, 12, 1989–2012.