Melasma

Have you noticed your skin sporting brown to greyish patches recently? This could be melasma. It's like your skin is wearing a mask of slightly darker patches, giving it a "two-toned" appearance. This is especially noticeable after you've been basking in the sun, perhaps after a sunny vacation or just from our everyday Singapore sunshine.

What is melasma?

As a dermatologist, I often meet patients concerned about melasma, a condition where brown to greyish patches appear on the face. Common spots include the cheeks, upper lip, nose, chin, and forehead. Many know melasma as the "mask of pregnancy" because it is quite common in pregnant women in Singapore. But here's some good news: melasma is benign and not harmful. It tends to come and go, with periods of improvement and sometimes reappearance.

Understanding melasma goes beyond just knowing where it appears. With advances in medical science, we've learned that melasma isn't just one-size-fits-all; it's more complex, showing variations that affect how we treat it.

• Epidermal melasma: epidermal melasma occurs in the upper layer of the skin, showing up as dark brown patches with clear edges. It responds well to creams and topical treatments because they can directly reach and affect this layer.
• Dermal: dermal melasma is found deeper in the skin and displays light brown or greyish patches with less defined borders. It is more stubborn and does not react as quickly to topical treatments.
• Mixed melasma: the most common form, mixed melasma, combines epidermal and dermal melasma components.

To determine which type you might have, we use a tool called a Wood's lamp. This special light helps us see the depth of the pigmentation in your skin, guiding us in choosing the best treatment for you.

At Lumine Dermatology & Laser Clinic, we understand the nuances of melasma, which allows us to craft personalised treatment plans. Whether your melasma is on the surface or deeper down, we're here to help you navigate this condition with advanced dermatological care.

What causes melasma?

Melasma is often linked to a combination of sun exposure and hormonal changes. In Singapore, where the sun shines brightly year-round, our skin is constantly exposed to ultraviolet (UV) rays, visible light, and even infrared radiation. Even if we stay indoors all the time, we are still subject to UVA, visible light, and infrared exposure.

These factors can significantly contribute to the development of melasma, especially when combined with hormonal shifts experienced during pregnancy or from the use of oral contraceptives. Or if there is a positive family history.

Recent studies have shed light on melasma being more than just a response to sun exposure and hormones. It's now seen as a sign of photoaging, which means the sun's rays have caused damage over time. This damage can manifest in several ways:

• A decrease in the cells that produce collagen, thus making the skin less firm and elastic.
• An increase in mast cells, part of your skin's defence system, can also contribute to inflammation and pigmentation when overly active.
• A weakening of the basement membrane, which is crucial for skin integrity.
• More blood vessels in the skin can add to melasma's appearance.

Treating melasma in Singapore poses unique challenges due to our constant exposure to intense sunlight and high humidity. These conditions can make treatment outcomes less predictable and relapse more common. However, understanding the multifaceted nature of melasma is the first step towards managing it effectively.

We can tailor a treatment plan that considers the specifics of our local environment, your lifestyle, and your skin's unique characteristics. Whether selecting the right sunscreen, exploring gentle yet effective treatments, or making lifestyle adjustments, there's a path forward to managing melasma in our tropical setting.

What are the symptoms of melasma?

Melasma predominantly occurs in three areas on the face; these areas are:

• Centrofacial: affects the forehead, cheeks, nose, and upper lip.
• Malar: appears on the cheeks and nose.
• Mandibular: appears along the jawline.

While melasma is not harmful, we understand that it can be a cosmetic concern. At Lumine Dermatology & Laser Clinic, we're equipped and ready to help you understand and manage melasma, tailoring treatments to suit your skin and lifestyle.

Who is at risk of melasma?

Melasma, a common form of hyperpigmentation, is more notable among Asians and mainly affects women. Melasma usually makes its first appearance in individuals in their mid-30s and can persist well into later years. It's especially prevalent during specific life stages and conditions unique to women.

• Pregnancy: often referred to as the "mask of pregnancy," melasma can affect up to 15-50% of pregnant women.
• Post-menopause: around 10% of cases occur after menopause, linked to hormonal changes.
• Sun exposure: living in sunny Singapore, our skin is constantly under the sun, whether for work or leisure. This exposure significantly increases the risk of developing melasma.
• Hormonal factors: the use of oral contraceptives or hormone replacement therapy can trigger melasma. However, stopping these treatments doesn't always lead to an improvement, indicating the condition's complex nature.
• Genetics: a family history of melasma means you are more likely to experience it.
• Skin type: those with Asian skin, particularly Fitzpatrick Skin Types III and IV, are more susceptible.

How is melasma diagnosed?

It’s crucial to distinguish melasma from other skin conditions that look similar but require different treatments.

Here’s how we do it.

• Initial examination: your journey begins with a thorough examination by our dermatologist. We'll discuss your medical history and any potential factors that could have contributed to the development of melasma.
• Wood’s lamp examination: this specialised light helps us assess the depth of melasma pigmentation in your skin, providing clues about the best treatment options.
• Dermatoscopic examination: we examine the pigmentation and its vascular components closer. This step is crucial for confirming the type of melasma and tailoring your treatment plan.
• Biopsy: melasma is a clinical diagnosis. However, it can sometimes be confused with other skin conditions. In these cases, we may recommend a skin biopsy to ensure an accurate diagnosis. One such condition we worry about is exogenous ochronosis, where the dark patches on the skin are due to the prolonged application of high-concentration hydroquinone.

What are the treatment options for melasma?

Melasma is a multifaceted condition influenced by photoaging, hormonal changes, increased blood vessel activity, and genetics. That's why our treatment strategies are comprehensive, targeting the root causes (aside from genetics) to not only treat melasma but also to maintain your skin's health.

Customised Melasma Treatments at Lumine

• Preventative care and education: during your consultation, we'll explore effective sun avoidance strategies and help you select sunscreens with the right ingredients for maximum protection.
• Topical treatments: our topical treatments include both hydroquinone and non-hydroquinone alternatives, such as cysteamine, resorcinol, niacinamide, and azelaic acid.
• Laser therapies: we offer laser treatments to address both the pigmentation and vascular components of melasma, including picosecond lasers, Q-switched lasers, non-ablative fractional laser (MOXI) for pigmentation, pulsed dye lasers for the vascular aspect, and radiofrequency microneedling to strengthen the basement membrane.
• Chemical peels: our 40% mandelic acid peel is specially chosen for its effectiveness in pigment removal.
• Oral medications: we also prescribe oral medications like tranexamic acid, which targets the vascular triggers of melasma, and medications which focus on the mast cells involved in the condition.

At Lumine Dermatology & Laser Clinic, your journey towards managing and overcoming melasma is a partnership. With our comprehensive range of treatments and a deep commitment to personalised care, we're here to guide you towards clearer, healthier skin.

Frequently asked questions

Can my melasma go away on its own?

Melasma can lighten over time, but it rarely disappears on its own. Persistent care, sun protection, especially against visible light, and dermatological treatments are often necessary for significant improvement or resolution. Regular consultation with a dermatologist is advisable for personalised guidance.

Is melasma preventable?

While melasma may not be entirely preventable, you can reduce the risk by consistently applying broad-spectrum sunscreen, avoiding excessive sun exposure, and managing hormonal factors. Avoidance of strong lasers and treatments that may aggravate rather than improve the condition is also recommended.

Is melasma a serious medical condition?

Melasma is generally not considered a serious medical condition. While it does not pose significant health risks, it can impact your appearance. You are not alone, as melasma affects many women to varying degrees. It is advisable to consult with your dermatologist for proper diagnosis and suitable management options based on your situation.