Melasma is a frequent concern of our patients and one that we see very often, especially in young women and high phototypes.

These are brownish spots that appear on the facial region and usually occur symmetrically on the forehead, cheekbones and upper lip. Although in some cases it affects other locations such as the forearms, this form usually appears around menopause.

What are the causes?

Different factors play a role in its origin, which makes treatment difficult and can be a challenge for the dermatologist.

Known factors include:

• Exposure to solar radiation, both ultraviolet and visible light.
• Hormonal changes: use of contraceptives, fertility treatments, pregnancy.
• Genetic predisposition: most patients have a family history of melasma.
• Skin colour: it is much more frequent in dark skin phototypes III to V.

How can we prevent melasma?

The most important factor for prevention is strict photoprotection. This must be broad-spectrum, used all year round and repeatedly.

Physical measures are another fundamental aspect; the use of hats, caps, sunglasses or seeking shade are indispensable measures to achieve correct control of the disease. In addition, sun exposure should be avoided during the central hours of the day.

Also, the selection of cosmetics adapted to skin with melasma can help to maintain the effects of the treatments. Here are some product recommendations.

How to treat melasma?

Before starting treatment for melasma, it is essential that the dermatologist makes a correct diagnosis, as this condition can be confused with other types of blemishes, and treatment can worsen the lesions if it is incorrectly selected.

Treatment must be individualised. We must consider the patient’s phototype, previous skin alterations (acne, rosacea, scars, seborrhoea, seborrhoeic or atopic dermatitis…) or the time of year in which we are going to treat it.

In terms of topical treatments, we find:

• Magistral formulas prescribed by the dermatologist that combine active ingredients at different concentrations depending on each case, and which may include hydroquinone, retinoids, glycolic acid, tranexamic acid, azelaic acid, kojic acid and even corticoids for a specific period of time to reduce the appearance of melasma.
• Chemical peels: these can be an effective treatment and are generally used as a complement to topical treatments. Here we can use various active ingredients in combination such as phenol, hydroquinone, glycolic acid, salicylic acid, trichloroacetic acid, etc., and generally at much higher concentrations than in cosmetics.
• Lasers and light sources: Although they are not considered a first-line treatment, they can be effective if combined with other treatments or when these are not effective. However, they should be used with caution and always by a dermatologist, as the risk of post-inflammatory hyperpigmentation is high. Some devices such as IPL (intense pulsed light) or picosecond laser can be effective.
• Oral tranexamic acid: this drug has been shown to be effective in the treatment of melasma; however, its use is off-label and the dermatologist must assess the risk-benefit ratio on an individual basis.
• Microneedling with depigmenting active ingredients. The small holes generated in the skin by the application of the devices with microneedles allow these products to enter the deep layers of the skin, achieving significant improvements in some cases, especially when combined with other treatments.

Despite all the treatments carried out, we must assume that, with all these tools, we intend to control (not eliminate) melasma, as it has a natural tendency to recur. The key to success in controlling melasma is correct diagnosis by the dermatologist and the combination of treatments according to the patient’s characteristics.

What cosmetics are suitable for melasma skin?

Here are some examples of cosmetics that can help control melasma skin (although they are not a treatment).

Photoprotectors: it is important that photoprotection is broad-spectrum (coverage against UVA, UVB, visible light and infrared), and should be applied frequently (every 2 hours if we are exposed).

1. Heliocare 360 Pigment Solution Fluid:
2. Fotoutra Age Repair Isdin
3. Advance Brightening UV Defense de Skinceuticals

Cleansers: This is a fundamental step in any routine as it helps to exfoliate and helps treatments to work more effectively

1. Rilastil Aqua face cleanser (https://rilastil.es/producto/aqua-limpiador-facial)
2. Bioderma Sebium Gel Moussant Actif (https://www.bioderma.es/nuestros-productos/sebium/gel-moussant-actif)
3. Basiko PS-Active Mousse de Cosmeclinik (https://cosmeclinik.com/en/basiko-sensitive-skin/basiko-ps-active-mousse-138)

Other cosmetics with depigmenting agents:

1. ACM Dépiwhit Lightening Film Mask (https://www.labo-acm.com/es/depiwhite/148-depiwhite-mascarilla-peliculable-aclarante-3760095250106.html)
2. Neoretin Discrom Control Concentrate by Neostrata (https://www.cantabrialabs.es/productos/neoretin-discrom-control-concentrate/)
3. Advanced Pigment Corrector by Skinceuticals (https://www.skinceuticals.com/advanced-pigment-corrector-883140023234.html)

La entrada How to treat melasma? se publicó primero en Dra. Sara Gómez Armayones.