This 3-part series explains in detail the common pigmentary issues we take care of at IYAC.

Melasma, Hori’s Nevus, Age or Sun Spots

This is by far the most common, yet challenging to treat, pigmentary condition. It’s not uncommon for patients with melasma to hop from clinic to clinic, in search of a “cure-all.” 

What we must understand, is that melasma cannot be cured, but it can be controlled.
 

What is Melasma?

Melasma appears as irregular patchy brown shadowing, typically over the cheeks, although the temples, forehead, nose bridge and around the lips can also be affected.

It affects more women (1 in 3) than men (1 in 10) and generally starts in our 30s, or if there are any hormonal triggers, like pregnancies, use of oral contraceptives or hormonal treatment, or menopause.

How is Melasma treated?

In short, melasma cannot be cured.

The main focus should be reducing the drivers of melasma.

• Hormonal: To some extent, this can be mitigated with an anti-inflammatory lifestyle and balancing some key nutrients within the body. Sleep early, reduce alcohol and take fresh whole foods high in antioxidants.
• UV exposure: Apply sufficient sunscreen (2 finger lengths to face and neck) with high SPF, UVA and UVB protection, and reapply regularly throughout the day.

What’s IYAC’s approach to Melasma?

Here, in addition to lifestyle tweaks, we tackle this difficult pigment using a multimodal approach.

Topicals:

• Pharmaceutical-grade creams containing cysteamine^1,2 (antioxidant) prevent and lighten pigments.

Orals:

• Medications help to lighten melasma and skin supplements can resist new pigment formation.

Skincare:

• Skin well-nourished and hydrated is less prone to new and stubborn pigments.
  • Use clean skincare that’s been formulated to contain botanical ingredients, with no nasties and with anti-pigment, moisturising and rejuvenation benefits.
• Sunscreen: Apply sufficiently (2 finger lengths to face and neck) with high SPF, UVA and UVB protection. Reapply regularly throughout the day.

Lasers:

• There are lasers which are FDA-approved for melasma – the Copper Bromide laser³ and the pico Alexandrite 755nm laser^4-7.
• These lasers break down pigments and lighten melasma over time; generally, at least 3 to 6 sessions are needed before any changes in pigments can be appreciated.
• In the treatment process, pigments can look darker for a few weeks after laser treatments, before gradually lightening up.

Melasma is unpredictable and can be recalcitrant, needing a less-is-more approach.

Speak with us at IYAC to let us guide you on a journey to clean and healthy skin.
 
 

References:

1. Besouw M, Masereeuw R, van den Heuvel L, Levtchenko E. Cysteamine: an old drug with new potential. Drug Discov Today. 2013 Aug;18(15-16):785-92. doi: 10.1016/j.drudis.2013.02.003. Epub 2013 Feb 14. PMID: 23416144.
2. Mansouri P, Farshi S, Hashemi Z, Kasraee B. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015 Jul;173(1):209-17. doi: 10.1111/bjd.13424. Epub 2015 May 29. PMID: 25251767.
3. Lee HI, Lim YY, Kim BJ, Kim MN, Min HJ, Hwang JH, Song KY. Clinicopathologic efficacy of copper bromide plus/yellow laser (578 nm with 511 nm) for treatment of melasma in Asian patients. Dermatol Surg. 2010 Jun;36(6):885-93. doi: 10.1111/j.1524-4725.2010.01564.x. Epub 2010 May 7. PMID: 20482724.
4. Wu DC, Goldman MP, Wat H, Chan HHL. A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations. Lasers Surg Med. 2021 Jan;53(1):9-49. doi: 10.1002/lsm.23244. Epub 2020 Apr 13. PMID: 32282094.
5. Lee YJ, Shin HJ, Noh TK, Choi KH, Chang SE. Treatment of Melasma and Post-Inflammatory Hyperpigmentation by a Picosecond 755-nm Alexandrite Laser in Asian Patients. Ann Dermatol. 2017 Dec;29(6):779-781. doi: 10.5021/ad.2017.29.6.779. Epub 2017 Oct 30. PMID: 29200769; PMCID: PMC5705362.
6. Chen YT, Lin ET, Chang CC, Lin BS, Chiang HM, Huang YH, Lin HY, Wang KY, Chang TM. Efficacy and Safety Evaluation of Picosecond Alexandrite Laser with a Diffractive Lens Array for Treatment of Melasma in Asian Patients by VISIA Imaging System. Photobiomodul Photomed Laser Surg. 2019 Sep;37(9):559-566. doi: 10.1089/photob.2019.4644. Epub 2019 Aug 14. PMID: 31411549.
7. Manuskiatti W, Yan C, Tantrapornpong P, Cembrano KAG, Techapichetvanich T, Wanitphakdeedecha R. A Prospective, Split-Face, Randomized Study Comparing a 755-nm Picosecond Laser With and Without Diffractive Lens Array in the Treatment of Melasma in Asians. Lasers Surg Med. 2021 Jan;53(1):95-103. doi: 10.1002/lsm.23312. Epub 2020 Aug 31. PMID: 32865858.