In spite of having to slap on the sun block and wear wide-brimmed hats to prevent sun damage to my skin I love living in sunny South Africa... and staying indoors is not really an option for me. Hence I need to make allowances for the fact that female hormones also aggravate the situation and take all the precautions I possibly can. Melasma, also known as hormonal pigmentation, is a very real problem for us on the southern tip of Africa. It manifests as brown patches on the face and is a condition that doesn’t go away and hence needs lifelong management.
Causes
- For once, the blondies do not suffer as much as darker-complexioned ladies, but because of the intense heat of the sun in SA, any skin colour can be affected.
- UVA rays stimulate the melanin in one’s skin which can cause brown patches to appear, you are not even safe in your car, as they penetrate the glass windows. That’s why sunblock is so important throughout the year, and not only during summer time!
- Anything that could change a woman’s hormonal status, such as birth control pills or pregnancy can cause or aggravate the brown spots, and there is no guarantee that stopping the birth control pills will clear the pigmentation. After pregnancy the melasma (chloasma) usually clears up within a few months, however there is always the possibility that it could persist for much longer.
- Other triggers could be anything that causes intense heat to the face such as steam baths or saunas, the area on the beach under an umbrella with sun block or a hot closed environment. It is the inflammatory process which stimulates the melanin to develop into melasma.
- This condition is much more prevalent in young women, but can be seen in men as well, where it mostly affects the forehead, cheekbones and jawline.
Types of Melasma and Recommended Treatment
The most common form of melasma is epidermal, which is very treatable with a combination of superficial chemical peels, Limelight™ or Photo Genesis™ procedures.
When the pigmentation has leached deeper into the skin it is known as dermal melasma and is best treated with mid dermal peels such as Skin Renewal’s 3D peel™, MesoBrite™ or MesoBrite Lite™ peels or with injectable mesotherapy. These treatments will penetrate into the dermis of the skin to reach the pigmentation and treat it.
Other Pigmentation
Freckles are common localised pigmentation areas that are more likely to affect fair-skinned people. They appear as flat brown pigmentation ‘spots’ and darken in summer, while being a lot less visible in winter.
The cause of Post Inflammatory Hyperpigmentation (PIH) is not clear, but may involve the mediators of inflammation and these brown marks usually appear after skin has been affected by acne, dermatitis or any skin inflammation. Sun exposure can make the condition worse, but topical therapies and treatments as mentioned above may help.
Sun spots appear as brown lesions, about one centimetre in diameter and found on the face and hands. They are found mostly in people over fifty but not as a result of age, but rather of prolonged sun exposure. This condition should be examined carefully as it could indicate whether an individual could have a greater risk of skin cancer.
Diagnosis
It is always better to consult a Skin Renewal doctor to rule out any other systemic diseases, or even to ensure that your condition is not a cancerous lesion that requires medical intervention. In addition they will take into consideration all other factors such as hormones, medications, etc. that could have caused or contributed to the pigmentation and make an informed diagnosis with all the facts at their disposal, making sure that you get the best advice and treatment options available.
Treatment and Home Care
So whether it is a superficial peel, Cosmelan or Dermamelan, injected Tranxemic acid mesotherapy or Laser Genesis treatment that is recommend, it will be in accordance with your individual needs and type of melasma.
All after care products, e.g. topical creams, a pigment inhibitor or lashings of sunblock should be used exactly as recommended and sunlight must be strictly avoided to ensure a better chance of successful treatment. Even after the pigmentation marks have faded or disappeared, care should always be taken to ensure that they do no reappear by following the guidelines given to you by your Skin Renewal doctors.