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Skin problems

Melasma Treatment

Melasma is a skin disorder whereby dark, irregular patches occur, usually, on the the cheeks, forehead, upper lip, chin, and the bridge of the nose. This skin condition happens to mostly women and usually affects the dark-skinned races such as Indians, Asians, Hispanics, Middle Easterners and Northern Africans.


Melasma is a type of hyperpigmentation, but compared to other forms of pigmentation, Melasma is more challenging to remove. According to a dermatology specialist named Romeo Morales, MD, FAAD, 9 out of 10 individuals affected by Melasma are women aged 20 to 50. 


It is crucial to take note that this skin condition is triggered by heat, so treatment should not involve or apply heat. Concerning this, heat-generated treatments like IPL treatment should be avoided; otherwise, the condition will worsen.

Causes of Melasma

Melasma has no exact known cause and is usually understood to be hereditary. Sometimes changes in hormones called Chloasma may also instigate Melasma and is generally linked with pregnancy. It is because of hormonal changes causing pigmentation levels to increase, and this occurs simultaneously with negative reactions, such as morning sickness, due to the hormonal fluctuations. However, in most cases, Melasma occurs temporarily and eventually clears up for a few months after the baby is born. 

Nevertheless, Melasma is primarily triggered by a combination of sun exposure and hormonal changes, particularly in levels of estrogen and progesterone. Birth control pills which affect hormonal changes can also contribute to Melasma. So, if oral contraceptives are ceased, or when it is winter or following pregnancy, there is a chance for Melasma to fade.

Melasma is sensitive to heat, so it is best to avoid situations where there is sun exposure on your face, or places like saunas and solariums, as they can trigger Melasma.

UV sun rays and light bulbs that emit strong light can cause this skin disorder as they stimulate pigment-producing cells in the skin. These cells known as Melanocytes are more active in people with colored skin and generate a bigger quantity of pigment when they are stimulated by light exposure or changes in hormone levels.


Preventive Measures Against Melasma  

While Melasma may disappear after pregnancy, there is no cure for this skin condition and which can sometimes remain for years to a lifetime. However, there are a number of methods to minimize the occurrence of Melasma. SPF 30 or higher sunblock lotions and creams can block UVA and UVB sunrays to prevent the penetration of ultraviolet radiation and visible light, hence, helping reduce Melasma.

The stopping of oral contraceptives like birth control pills may also help. Facial products that irritate the skin should be discontinued as this worsens Melasma. These includes make-up, cleansers and creams.


Treatment and Surgery for Melasma

  • Bleaching Creams

There is a selection of bleaching creams which reduces the activity of the pigment-producing cells. These creams often contain tretinoin, glycolic acid, steroids, hydroquinone, azelaic acid and kojic acid, and can be obtained over-the-counter. For more severe cases of Melasma, doctors may prescribe higher-concentrated creams.


  • Cosmetic Surgeries

There are cosmetic surgeries which are available now to treat Melasma such as Chemical Peels, Laser Surgery and Microdermabrasion. These procedures are inconsistent and may cause skin irriataion but when performed by an experienced dermatologist, combined with diligent application or bleaching creams tailored to your type of skin, Melasma can vastly improve.


In Singapore, Pico Lasers used for pigmentation removal have shown to be effective for people with Melasma, and this offers fewer side effects and lesser downtime compared to ablative lasers such as CO2 laser or low-energy ND:YAG lasers. This laser treatment can destroy pigment-producing cells and cause dispersion of the melanin. 


The first line treatment used in Singapore involves a triple combination cream, which contains hydroquinone, tretinoin, and a steroid.  Hydroquinone is a skin lightening medicine that reduces melanin synthesis by inhibiting the enzyme involved in the process.

The tretinoin, which is a Vitamin A-based cream, improves melanin removal by increasing cell turnover and reducing melanocytic activity. On the other hand, the steroid cream, which is mild in potency, is focused on reducing skin irritation caused by the first two products and facilitates further pigmentation reduction.

The triple cream is more effective when performed under a dermatologist’s care. Although Melasma can be stubborn, following your dermatologist’s advice will help you benefit from the treatment.  Once your Melasma fades, maintenance therapy will take place. This involves a continuous treatment of your skin by means of wearing sunscreen, or a wide-brimmed hat every day.

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