Many factors contribute to the appearance of melasma. If you’ve not paid much attention to sun protection in your younger days, melasma would come to haunt you from around mid 30s!
The archenemy of women, melasma is a common facial pigmentation afflicting thousands of females in Asia, leading to considerable distress. Commonly starting around mid-30s, melasma usually appears as symmetrical, blotchy, brownish pigmentation on the cheeks, forehead, upper lip and nose.
Many factors contribute to the appearance of melasma e.g. pregnancy, usage of birth control pills, sun exposure and family history of melasma. If you’ve not paid much attention to sun protection in your younger days, melasma would come to haunt you from around mid 30s!
It is straightforward to diagnose Melasma. Occasionally, other skin conditions like Lichen Planus Pigmentosus or mixed Hori with melasma may mimic melasma and lead to some uncertainty. Hence consulting an experienced dermatologist is prudent.
The general goal of melasma treatment is to lighten 30-90 % of the facial pigmentation. We have had good success with our treatment approach so far and many patients have responded really well. But its recurrence rate is high and ongoing sun avoidance is very important!
Commonly, a combination of the following measures is used:
Thorough and careful sun protection is key to lightening melasma and preventing its recurrence. People who work under the sun or who enjoy outdoor sports under the sun will have a challenging task to achieve success in their melasma treatment.
Topical tretinoin, lightening cream and chemical peeling is the cornerstone of melasma treatment. This should be the foundation before any laser treatment is offered. During an international pigmentation meeting here in Singapore, an American Professor of Dermatology, who was the session chairperson; chided a speaker for her reliance on using only laser treatment to treat melasma. He lamented, “ I don’t understand why this fascination with laser only when evidence based lightening cream should be used in the first place!”
Low dose oral tranexamic acid is an effective and safe treatment for melasma, provided patients are at low risk of stroke or thromboembolic disease. In Asia nowadays, the use of oral tranexamic acid together with creams has become very popular and the norm in treating melasma.
Laser treatment works beautifully when used in combination with topical creams. In Assurance skin, Q-switched ND:YAG lasers like Helios III are our go to options to hasten the lightening of melasma.
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