Dealing with pigmentation continues to be a struggle but as we learn more about the condition, we are adding some useful tools. Here are some of them.
An estimated six million women throughout the US are currently affected by melasma (also known as chloasma). This is a specific type of pigmentation problem thought to be caused by stimulation of the pigment-producing cells (melanocytes), and by the hormones estrogen and progesterone, when exposed to the sun and/or heat. Melasma is often referred to as the “mask of pregnancy” as the skin often darkens at this time, but the birth control pill and HT (hormone therapy) can also trigger a response. Other factors implicated in this annoying skin condition are certain medications that can cause photosensitivity, and cosmetics and fragrances that contain alcohol.
There are actually two kinds of melasma: epidermal, which is the most common and treatable type, and dermal, which is seen less often. Dermal melasma is light brown in color and has ill-defined borders. It is best treated topically with mandelic acid (an AHA derived from bitter almonds) and can often turn darker if treated with IPL (Intense Pulsed Laser) or laser protocols. Epidermal melasma generally has well defined borders and is dark brown in color.
There are several popular topicals currently being recommended for this type of melasma, primarily tyrosinase inhibitors but including bleaching and lightening agents. Tyrosinase is the enzyme responsible for catalyzing melanin, so inhibiting the action of tyrosinase is quite effective in reducing pigmentation issues.
The tyrosinase inhibitors are:
Kojic acid, derived from fungus
Arbutin, derived from the leaves of uva-ursi, the bearberry plant
Liquorice extract, taken from the root of the plant
Rumex extract, derived from the field dock
Niacinamide, also known as Vitamin B
Mulberry leaf extract
Other topical agents:
Vitamin C, a skin lightener and antioxidant derived from ascorbic acid
Tretonin, a skin exfoliator prescribed as Tazarac or Retin-A
Azelaic acid, a bleaching agent derived from barley, wheat and rye grains
Hydroquinone is still the most single effective bleaching treatment for melasma, but there are side effects attributed to this topical and some countries have banned its use. In fact, the FDA is now considering banning the sale of 2% OTC (over the counter) hydroquinone in the US and making it available by prescription only. If you are using it to treat melasma, watch for any irritation, redness and unusual discoloration.
The advantage of using topicals on the above list is that when combined properly, they can outweigh the benefits of hydroquinone and they have no side effects when used correctly.
At SkinSense, we have found that ultrasound used with some of these topicals, particularly Vitamins C and A, during a facial treatment, helps to fade the pigmentation more rapidly by aiding penetration. Modified chemical peels alternated with regular applications of AHAs also speed results.
The client needs patience and persistance when tackling this condition because results are gradual. We recommend postponing spa treatments until the cooler weather sets in. As mentioned earlier, heat alone can cause pigmentation, so wait until fall and winter to start treatments. During the summer, we recommend deep-cleaning facials, lots of sunscreen, shade and wide-brimmed hats.