If there is a topic that they ask us a lot about, it is stains. And, above all, of melasma: that rebellious hyperpigmentation that usually comes out of a lot of sun exposure or during pregnancy. It is usually annoying and, in addition, it is difficult to treat and tends to come out again. While melasma continues to be a therapeutic challenge, there are plenty of treatment options. We did a review on the issue and everything that can be done to prevent (ideal) or combat it. 😉
What is melasma?
It is the appearance of spots due to an increase in the activity of melanocytes (cells that produce melanin, the pigment of the skin). They are usually symmetrical, with irregular edges and generally appear on the face. It is more frequent in women and, within these, in those with darker skin (Fitzpatrick IV to VI) 1 , contrary to what one would tend to think.
Is it frequent?
Depending on the study and the population in which it is measured, the frequency varies greatly (between 1% and 50%!) 1 , possibly due to different skin types and different degrees of sun exposure depending on the region. Particularly in the Latino population, a study showed a prevalence of 8.8% 2 .
When does it come out?
The average age of onset is between 20 and 30 years 3 , 4 . When the spots appear in pregnancy , the most common is that they appear in the second half and that they disappear within a year after delivery 5 . An important fact is that a study carried out in 2007 showed that applying SPF 50 every day every 2 hours reduces the chances of melasma appearing during pregnancy 6 (believe us, we would love to have a less tedious option!).
What causes it?
It is typical to associate stains with exposure to UV rays , and without a doubt this is one of the main factors that cause them. Both sun exposure and tanning beds are triggers for melasma. Furthermore, a genetic predisposition is presumed, as 55% to 64% of people with melasma have a family history. Finally, hormones are known to play an important role: the frequency of melasma increases in pregnant women and women taking oral contraceptives or hormone replacement therapy 1 . In fact, the reported risk of developing melasma when starting combined hormonal contraceptives is 8% to 34% 7.
It is worth clarifying that not all pregnant women will have melasma, nor will all those who sunbathe or have relatives with this condition: it is the interaction between the factors that ends up determining its appearance.
Where does it appears?
The most frequent areas are three:
- in the center of the face (forehead, nose and mouth -the most annoying in general-)
- in the malar areas (below the dark circles)
- and in the jaw area
The most typical presentation (50-80%) is in the areas of the center of the face. Less frequently, spots may also appear in areas such as the neck, chest and arms (extra-facial melasma) 1 .
What happens at the skin level?
Hyperpigmentation occurs that can be of the epidermis (most superficial layer), of the dermis (the next layer in depth) or mixed 1 . They have some differences, but – broadly speaking – what happens is that the melanocytes (pigment-producing cells) are larger and more loaded with pigment 8 , which translates into a brown spot that can be seen with the naked eye.
What to do about it?
Although melasma is chronic and tends to be stubborn and return, 9 there are several effective treatment options worth trying. These include topical products (creams), peels, and other procedures (such as lasers). You can choose one option or combine them, which is recommended because it has been shown to give better results 1 . * There is a fundamental pillar that is common to all options and that also helps prevent: UV protection . No melasma treatment is going to be effective if we don’t take care of the sun. So that is without a doubt the first tip to consider. 😉 It is also recommended to stop hormone treatments (such as contraceptives and hormone replacement therapy) whenever possible.
There are several depigmenting actives that work and are usually the treatment of choice to start with. The most common are:
- Ascorbic Acid (Vitamin C) – eye other than a derivative, they are less effective!
- Vitamin B3 (Niacinamide)
- Azelaic Acid
- Kojic acid
- Dioic Acid
Hydroquinone, Ascorbic Acid (Vitamin C) , Azelaic Acid and Kojic Acid depigment because they inhibit the enzyme that produces melanin (the pigment of the skin). Ascorbic Acid has the additional benefit of being photoprotective due to its antioxidant action (that is, it adds protection against sun damage). The Niacinamide (Vitamin B3) , meanwhile, does not diminish the formation of pigment, but interferes with the passage of the melanocyte to the shallowest (and visible) skin cells. Dioic Acid interferes with melanin synthesis by inhibiting the transcription of the enzyme that forms it, and inhibits its passage to surface cells 10 (like Niacinamide). Retinoids stimulate keratinocyte turnover, so they can also help, but the results are more long-term. Corticosteroids, finally, help by their anti-inflammatory action, which reduces the production of pigment 1 . As their mechanisms of action are different, they give very good results when combined. Several creams contain more than one of these ingredients and are effective. We leave you some options:
- Tri-Luma : combines Hydroquinone with a retinoid (Tretinoin) and a corticosteroid (Fluocinolone). eye! It is not recommended to use in summer.
- Eucerin Anti-Pigment : combines Dioic Acid with sun protection.
- Our Stain Kit : includes Ascorbic Acid (Vitamin C) and Niacinamide (Vitamin B3) Boosters , to apply one AM and the other PM under the moisturizer. They can be used all year round (even in summer) and are a treatment that can be sustained: there is no problem with long-term use, quite the opposite. They treat beyond the stain: they leave the skin divine in many ways! 🙂 We recommend combining it with our MA Exfoliating Toner , which has also proven effective in improving melasma. Together, they give an incredible result! You can find all three together with a discount in our VIT-C / FE + VITB3 / Zn Plus Kit .
- Our SPF 30 UVA + UVBA : in addition to broad spectrum UV protection, it contains two additional active ingredients: Resveratrol and Ferulic Acid. Both are antioxidants (help prevent damage) and depigmenting.
It is worth clarifying that although Hydroquinone is considered the gold standard of treatment for melasma, its safety is a matter of debate because it can have no minor adverse effects – the European Union even prohibited its use in cosmetics 9 . That is why the other alternatives have gained relevance and have been studied a lot: they are always compared with Hydroquinone and it is sought that they equal or exceed their effectiveness. Of course, while the alternatives are welcome for this reason, this does not mean that Hydroquinone cannot be used: we only recommend that it be prescribed and controlled by a doctor. * Note: For the alternatives to be as effective as Hydroquinone, the concentration at which the active ingredients are formulated is especially important. It is not enough for a cream to claim to have an asset (Vitamin C, for example): it must have it at the right concentration and pH for it to work.
They are generally used to support topical treatment. They are especially useful in resistant cases. We must be more careful with peels the darker our skin is, because it has a greater risk of staining from the treatment (being left with areas darker or lighter than the rest of the skin). That is why putting ourselves in the hands of trusted cosmetologists and dermatologists is vital. On which peels are indicated for melasma, the most common are those of Glycolic, Salicylic, TCA and Tretinoin 9 . Those containing Mandelic Acid 11 are also very useful . They are generally not recommended in summer, because they require extreme sun care.* Note: They are effective especially in epidermal (superficial) melasma. If it doesn’t work for you, your hyperpigmentation may be dermal (from a deeper layer).
Mesotherapy, dermabrasion and laser treatments (especially the latter) are other alternatives to consider but not as a first option: they are recommended when other treatments fail and as a complement (in addition to always being accompanied by SPF). Care must be taken in the case of laser therapies with the risk of hyperpigmentation (it can cause more spots) 9 . We hope you have found it useful and do not hesitate to tell us if any treatment has been effective for you. We are at your service for any questions! 😉 Until next post, The Chemist Look Team