Irregular pigmentation is the most common skin condition that we as skin care professionals see on a daily basis. The enormous range and variations we see in skin colour is due to the pigment called melanin. Hyperpigmentation is the overproduction of Melanin. Every person has the same number of Melanocytes (cells that produce the pigment melanin), the difference is that some melanocytes are more active in some individuals than others.
When identifying the cause of pigmentation generally all causes will be found in conjunction with UVR exposure coupled with one of the following; medication, hormonal influence, vitamin A and C deficiencies, a chemical substance as well as essential fatty acid deficiencies.
The general rule of thumb when identifying hyperpigmentation:
- Hormonal pigmentation is generally found central-facial (top lip, cheekbones and forehead) e.g. Melasma.
- Sun Damage is found on the outer areas of the face towards the hairline.
- Irregular shaped pigmentations that are found in odd places are usually due to trauma and termed post inflammatory hyperpigmentation.
Melasma and its Triggers
Melasma is perhaps the most challenging pigmentary disorder to treat. It is often also referred to as Chloasma or the mask of pregnancy. While it can occur in both men and women it mostly affects women of child bearing age.
This pesky hyperpigmentary disorder is often brought about by pregnancy, the contraceptive pill as well as mild ovarian or thyroid dysfunction and some photosensitising medications. A genetic predisposition is also a common factor in the development of Melasma. Fitzpatrick skin types 3 and 4 (light brown skins) are more prone to the development of Melasma although lighter skins also have a high risk of development especially if it is evident in their family history.
Epidermal Melasma, meaning that it sits in the layers closer to the surface of the skin, is known to fade over time after women have given birth or gone off contraceptive medication. Chronic sun exposure can aggravate Melasma and cause it to extend deeper into the skin thus becoming dermal melasma which can be a very complicated condition to treat.
Treatment of Melasma
When treating Melasma the most important step is determining the cause. Once the cause has been identified, we can then address the particular cause and have a more effective outcome with combined treatment of at home skincare products and in clinic treatment. Hormone induced Melasma is best treated when you are finished breastfeeding or have changed your contraception medication. Precaution needs to be taken when exposing your skin to heat as well as UVR as you can inadvertently worsen the melasma by triggering inflammation in the skin. Melasma can worsen during times of stress due to the stress hormone cortisol causing inflammation.Tackling the inflammation before the pigmentation therefore may be the best course of action for some individuals.
Key points to remember when treating melasma:
- Identify the cause.
- Have a strict skincare routine that cuts out exposure to heat and sun.
- Discipline with sun protection is the most important key factor.
- Persistence and patience is key to keep the pigmentation at bay.
- Treating melasma takes time and unfortunately there is not a once off fix.
Dr Wade’s Recommendation for Treatment of Melasma:
Book for an online consultation with one of our skin specialists so they may analyse your skin and go through your skincare history in order to develop the most effective treatment plan going forward.