Call it melasma, hyperpigmentation, mask of pregnancy, discolouration or anything fancy, these are far from fancy when they conceal your beauty with dark patches on the upper cheeks, the nose, lips, upper lip and/or forehead. Melasma is a very common skin problem particularly amongst women. It is exacerbated by sun exposure, pregnancy, oral contraceptives and certain anti-epilepsy drugs. As common as it is, there is no permanent cure, so be cautious and take steps to prevent it.
What makes you a likely candidate for melasma?
Although a person of any race can be affected, it is much more common in constitutionally darker skin types, especially Asians from tropical countries. About 70% to 80% of Thai patients will have it at some point, whereas Caucasians who usually get freckles rarely develop melasma. It’s only when Caucasians come to Asia, and are exposed to the sun, those who are able to a tan easily, will begin to get these pigment patches on the face. Melasma is the mechanism of the body to produce more pigment to protect the skin from sun damage such as wrinkles and cancer. For Caucasians, melasma is easier to treat and often fades away once they return to their country and are no longer exposed to the sun. Since Asian melasma depends on skin type, hormones and a host of other factors, once Asians develop melasma, the skin continues to produce that level of pigment making it quite difficult to get rid of.
It’s rare to develop hyperpigmentation before puberty as it’s more common when you get older. If you’re not exposed to the sun very much and you’re quite careful, then it happens at an even later age. Melasma is most common in women during their reproductive years. When you’re pregnant your hormones make your skin more sensitive to the sun. Since men don’t have these hormones that stimulate the production of pigments like women, they rarely suffer from hyperpigmentation, unless they are a golfer, a farmer or work in an occupation that requires staying out in the fields a lot.
Do the treatments for Asian and Caucasian skin differ?
In the case of mild pigmentation, over-the-counter topical bleaching agents containing vitamin C and plant extracts like mulberry can be effective for both skin types. Medical whitening agents such as hydroquinone and Retin-A, will also help to bleach stubborn pigment patches faster. However, it is important not use these creams for too long because they can permanently damage the pigment cell, creating a rebound effect _ once you stop the medication it can become worse, with spots of white and brown.
For a quick and more effective remedy, we can use pigment specific lasers or chemical or laser peels. The newest and most effective form of peeling is sublative rejuvenation. By utilising RF sublation, a fractionated bipolar radio frequency technology, heat energy is effectively placed into the dermis where it can produce significant dermal impact with minimal epidermal disruption. It takes only about 15-20 minutes and has minimal downtime.
In Caucasians, we can be more aggressive because after the treatment when they return home, they face less exposure to the sun. In Asians, we peel more cautiously and mildly because after peeling the skin gets even more exposed to the sun, which can in turn create a rebound from the pigment cells resulting in more pigment. So for Asians, I recommend not to do too much. For example, some people resort to peeling as soon as they see signs of pigmentation, but the more you peel the worse it gets. So if you do decide to get treated to get rid of the dark patches, you have to stay away from the sun or the patches will return. There’s no permanent cure. You’ll just have to be very cautious.
Can you suggest ways to prevent hyperpigmentation?
Stay away from the sun. If you have to go in the sun, make sure you apply sunscreen. When choosing your sunscreen, anything with an SPF beyond 30 is practically the same. Find one with both UVA and UVB protection, which means you need SPF (UVB) and PA++, because it is UVA that stimulates melasma, while UVB is responsible for skin cancer. The most important thing about sunscreen is if you’re highly exposed to the sun, you’ll need to reapply it every couple of hours. Birth control pills or other hormonal intakes also stimulate pigmentation so they should be avoided too.