Seeing brown spots or patches on your face during or after pregnancy?

It could be Melasma.

Unknown to many, those who are have a darker skin tone are more prone to developing Melasma as a reaction to sun exposure. Unfortunately, Melasma is a chronic recurring condition that cannot be fully cured. However, it can be treated and controlled satisfactorily.

Photo source: The Wellness Clinic

Besides treatment with topical creams, laser therapies and chemical peels are the other treatment options for those suffering from Melasma. However, these can sometimes lead to Post-Inflammatory Hyperpigmentation especially in Asians.

Here are some commonly asked questions about Melasma.

What is Melasma? How can one tell if one is suffering from Melasma?

Melasma is one of the most common pigmentation problems that occurs in Asians, usually seen in women between 20 – 50 years of age. It typically appears as a patchy brown pigmentation or greyish discolouration on the upper cheeks, upper lip, forehead, and chin. It is commonly called the “mask of pregnancy”, as it is believed to occur more frequently during pregnancy. It can also occur when a woman is taking oral contraceptives.

How does Melasma come about?

The exact cause of Melasma remains unknown. Experts believe that the dark patches in Melasma could be triggered by several factors, including pregnancy, birth control pills, hormone replacement therapy, and genetic predisposition. Uncontrolled sunlight exposure is considered the leading cause of Melasma, especially in individuals with a genetic predisposition to this condition.

What are the steps patients suffering from Melasma can take during the pregnancy to manage the condition and prevent it from getting worse?

Women who experience symptoms of Melasma during pregnancy should take all possible precautions to minimise UV exposure, as treatment with lightening creams and laser treatments are not advisable during pregnancy. This includes using a sunblock with high SPF and UVA protection, as well as wearing a hat and sunglasses when exposed to sunlight.

In most cases, Melasma will spontaneously clear after pregnancy, once the hormonal levels return to normal. However, in some cases, the pigmentation does not improve even after pregnancy. Patients with persistent Melasma can seek treatment once they stop breast feeding.

What are the various treatment options available to patients once they have given birth? What are the pros and cons of each of these options?

The first line of treatment for Melasma is specially formulated creams that contain lightening agents such as hydroquinone, azelaic acid, kojic acid and tretinoin. Possible side effects of topical applications include temporary skin irritation causing redness, itchiness and peeling.

In conjunction with home cream application, doctors’ treatments include chemical peels, and laser therapy. These additional treatments may be useful for some cases of Melasma, although the beneficial effects vary amongst patients.

Many types and strengths of chemical peels are available for different skin types. The type of peel should be tailored for each individual and selected by the physician. Patients who have sensitive skin types may be unsuitable for chemical peels.

Lasers have revolutionized the treatment of many skin conditions and one of these is hyperpigmentation disorders. Lasers have been widely used with variable success for the treatment of pigmented conditions which include sun spots, birth marks, tattoos, Melasma, and post-inflammatory hyperpigmentation (PIH). Although many pigmentary disorders have shown good results with laser treatment, the efficacy and safety of lasers for Melasma is still controversial.

What treatment options are safest to prevent the risk of Post-Inflammatory Hyperpigmentation (PIH)?

The main concern with using lasers to treat Melasma has been that even the slightest build-up of heat in the skin from the treatment could trigger PIH, which may cause additional pigment production and effectively make the Melasma appear darker after treatment. To circumvent this problem, doctors have had to use very low energy levels when treating Melasma, but this often leads to a very slow or even no significant improvement in the Melasma pigmentation.

The use of lightening creams for at least 2 months prior to the first laser session, and continued throughout the course of laser treatment has reduced the incidence of PIH significantly, but not in all cases.

The recent innovation of Picosecond laser technology has shown promising results in the management of Melasma. Picosecond lasers deliver enough energy to break down skin pigmentation in one-trillionth of a second.

Decreasing the time it takes to deliver the energy to an ultra-short pulse duration reduces heat build-up in the skin significantly, which in turn promises to reduce the incidence of PIH. It is also hoped that picosecond laser technology can reduce the number of treatment sessions needed by half, which in turn would reduce the risk of complications such as PIH.

These questions were answered by Dr Ram Nath, Medical Director of The Wellness Clinic at Camden Medical Centre.