Pigmentation is a general term used for darkening of the skin. One of the more common types of hyperpigmentation is post-inflammatory hyperpigmentation. This is where one gets an inflammatory process of the skin and in patients with a darker skin, this leaves a darker area on the skin. Common causes would be post-inflammatory hyperpigmentation caused by acne or by any injury to the skin such as a burn. Post-inflammatory hyperpigmentation that is caused by acne may be treated with topical hydroquinone or acelyic acid, such as Skinoren.
Melasma is caused by an overproduction of melanin by the pigment cells i.e. melanocytes.
Melasma has the following causes:
- Patient’s Skin Type: It tends to occur in people with a darker or move olive skin;
- Hormonal Factors: Pregnancy or the oral contraceptive will often bring about Melasma
- Sun Exposure: Just one day of excessive sun without an sunscreen can produce Melasma.
There are essentially two types of Melasma:
Epidermal Melasma is where the pigment is situated in the top layer of the skin i.e. the epidermis. If the melasma is present for a long period time, the pigment falls through the base membrane zone into the dermis. This is called Dermal Melasma and is much more difficult to treat.
The epidermal form of melasma may just disappear with adequate sunscreen but as mentioned, the dermal form of melasma tends to be chronic and often one will not obtain total clearance of the melasma with whatever treatment modality one would use.
The mainstay of treatment for melasma is topical hydroquinone in various concentrations and used in various bases. Other treatments would include Skinoren Gel® , Kojic Acid, Peptides and topical Alpha-Hydroxy Acids (AHAs). I tend to start the patient off on a topical hydroquinone mixture to improve the melasma and then to maintain the patient, I prescribe Neostrata Pigment Lightening Gel® or Lumixyl®.
A very important part of the treatment is sun avoidance and the use of a broad spectrum high factor sunscreen such as Heliocare Gel® , as exposure to ultraviolet radiation can make the condition worse because it activates melanocytes in the skin.
As mentioned previously, unfortunately the deep dermal form of melasma tends to be a chronic condition and is therefore more controllable rather than curable.