Diagnosing and Treating Melasma
Melasma is a complex skin condition that begins with inflammation or hormonal imbalance that signals the brain. Thus begins a series of triggers resulting in excess pigment in either the epidermal or dermal layer – or both.
Melasma affects men and women, although only 10% of all men will be afflicted with the condition. Melasma most often affects women between the ages of 20 – 50 and is primarily attributed to hormonal fluctuations. For instance, women in their 20s and 30s who take oral contraceptives often develop melasma. For those women in their 40s and 50s, the onset on menopause can trigger the condition. Pregnancy is another cause of melasma due to the imbalance of hormones, but the condition normally disappears after gestation.
Steps in Diagnosing Melasma
According to the American Academy of Dermatology, diagnosing melasma is a relatively simple three-step process that starts with a Wood’s Lamp. However, if there is any doubt, your Dermatologist may take a small sample of skin (a biopsy) to confirm the findings.
Step 1 – First, your skincare professional needs to determine the depth of the melasma in order to appropriately treat the condition. This is best achieved with a Wood’s Lamp.
Epidermal – If pigment is superficial it will fluoresce under the Wood’s Lamp, indicating that the melasma is on the uppermost layers of the skin. In this instance, topical skin lighteners or light chemical peels usually lift the pigmented lesions successfully.
Dermal – If pigment has reached the dermal layer, it will not fluoresce under the Wood’s Lamp. The appearance of pigment in the Dermis might require micro-dermabrasion and a series of medium-depth chemical peels to lift the melasma.
Epidermal & Dermal – pigment that appears in both layers will require a multi-tiered approach that might include topical lighteners or microdermabrasion, and medium-depth peels to correct the problem.
Step 2 – Next, your skincare professional will classify the melasma. Most melasma appears on the face, however, melasma can also be present on the arms, chest or neck. There are three common classifications for the face – they are:
Centrofacial – this is the central part of the face and is the most common site of melasma – making up about 64% of all cases
Malar – this is the cheek and nose area and it accounts for approximately 21% of all cases of melasma
Mandibular – this is the jawline area – about 17% of all cases of melasma can be located here.
- Less than 10% of the area with faint hyperpigmentation = MASI Score 1
- 10 – 29% of the area with mild hyperpigmentation = MASI Score 2
- 30 – 49% of the area with moderate hyperpigmentation = MASI Score 3
- 50 – 69% of the area with severe hyperpigmentation = MASI Score 4
With all classifications performed, your skincare professional can embark on the right approach for treating your melasma. Treating melasma can be difficult though, that’s because the pigment can appear in the Epidermis and Dermal layers. That said, the most common forms of treatment include:
Skin lighteners like Hydroquinone are the most common, although, controversial treatment that lightens the skin. To boost skin lightening, your doctor may prescribe tretinoin or a corticosteroid cream. Skin lightening treatments don’t always work, and hydroquinone is not safe for long-term use. Learn more about Skin Lightening here.
Microdermabrasion is the mechanical exfoliation of the top layer of the skin using a small machine that blasts tiny crystals over the skin to exfoliate the top layer. A diamond tip device might also be used to abrade the surface of the skin and remove superficial melasma. Microdermabrasion is often used before a chemical peel to help with penetration of the chemicals – this is an approach used when melasma is present in the Epidermis and Dermis layers. Want to learn more about Microdermabrasion – click the link.
Chemical peels are an effective course of action and generally deliver positive results. Chemical peels exfoliate the skin and lift existing pigmentation. There are different types of chemicals that can be used – learn more about these in our article on Chemical Peels
Lasers can be used to treat melasma, but it is not the preferred approach since the results are only temporary and in some cases, melasma could darken after laser treatment depending on your skin color. Before agreeing to laser treatments, learn more about them in our article Laser Treatments
Melasma is often difficult to treat and in many cases may take months before you see improvement. If you do begin treatment, it’s important to follow your skincare professional’s advice to avoid irritation, complications and prevent future damage.