Managing melasma

Melasma often affects the face, particularly in women. While it poses no health risks, its impact on self-esteem can be significant. Effective management involves a combination approach, including medications, skin care and laser treatments.

Sun protection

Melasma pigmentation is extremely responsive to light; ultraviolet and visible wavelengths of light can make symptoms worse.

Without careful attention to sun protection every day — even in winter — melasma is unlikely to improve.

Apply a broad spectrum SPF50 sunscreen every day, even in winter. A physical sunscreen containing zinc oxide or titanium dioxide will provide better protection against a wider range of light wavelengths.

Avoid the sun as much as possible, especially in the middle of the day. Wear a broad-brimmed hat and sunglasses when outside.

Topical skin care and over-the-counter medications

Topical skin care products can help reduce pigmentation in different ways, so it’s useful to use a combination of products.

Hydroquinone inhibits melanin production and is the most powerful over-the-counter pigment-fading product. It can cause skin irritation, so should be used with caution.

Topical vitamin C and niacinamide are both helpful in reducing pigmentation.

Medications

Your doctor may prescribe medication to fade pigmentation.

Tretinoin is often used to treat sun-damaged and ageing skin. It enhances cell turnover and has been shown to lighten pigmentation.

Kligman’s formula combines hydroquinone, tretinoin, and steroid, which reduces the irritant effects of the other ingredients. For maximum benefit, it usually needs to be used for several months.

Tranexamic acid can be taken orally to improve melasma. However, it can cause multiple side effects, including blood clots. It’s not safe for smokers, people taking oral contraceptives, those with a previous history of thrombosis/embolism and pregnant patients.

Laser

Laser treatments can fade pigmentation and target the blood vessels associated with melasma. Fractional laser treatment stimulates the production of new skin cells and also fades pigmentation. We use a 4-step laser approach known as MaQX Clear.

It’s common for melasma to recur after laser treatment, and in patients with darker skin, some forms of laser treatment can cause further pigmentation issues. Therefore, laser treatment is only recommended after other treatments have already been tried.

Maintenance

Melasma management requires consistency. Results may take many months, and it’s easy to backslide if you’re not diligent.