A Dermatologist's Guide To Treating Melasma - Update!!!

I see more patients for hyperpigmentation than ever before - women (and men) are really starting to grasp that addressing uneven skin tone is a powerful beauty fix. Lines and wrinkles matter much less when the skin reflects the light and is a clean, bright canvas - which doesn’t happen when there are brown, light-absorbing splodges everywhere.

Perhaps the commonest pigmentation disorder I see is melasma - brown patches, which can appear on the cheekbones, the forehead and upper lip (known as centro-facial melasma). Sun is a critical trigger;  it’s also often triggered by a hormonal change like starting the oral Contraceptive Pill, pregnancy or even HRT. If a new medication is the provoking influence, stopping it can resolve melasma, but alas not always. It can be very difficult to treat and very commonly, can be made worse by ‘physical’ treatments likes microdermabrasion, laser and chemical peels (especially in inexperienced hands).

I treat it in clinic with a medical-grade skincare system (usually a tailored Obagi Nuderm plan) combining multiple ‘actives’ to subdue the over-active pigment cells and eliminate the excess pigment already in the skin. Given that problems like this are often an inherent part of you, and tend to require a long-term strategy, this approach works well. I will rotate them through more aggressive treatment cycles in summer or before big events, and then step down to a more gentle maintenance strategy in ‘off-peak’ parts of the year. In resistant cases I’ve been getting great results with oral tranexamic acid, a drug traditionally used to treat heavy periods. It’s being used off-licence at present but the evidence base is growing steadily so hopefully this will change soon.

A critical part of our success is equipping patients with top-quality sunscreen - the one product I think merits a bit of a splurge. Why? Because almost EVERYONE under applies it - the reasons vary. ‘It makes me break out’,’ it makes my make-up slide off,’ ‘I look white’. It’s the most important anti-ageing ingredient we have, provided it’s used correctly. Hence the need for an elegant one  -and I like sunscreens which utilize physical blocker Zinc Oxide in treating melasma, so UV is deflected away from the skin like a mirror. I also make sure patients are equipped with water-resistant SPF for hot weather/outdoor activity, usually in a tinted format so it provides a little coverage as well. The final consideration is using sunscreen and make-up that contains Iron Oxide, as we know it blocks visible light, (which is also a melasma driver – grrrrr.)

Patients’ self-confidence can be transformed-and from a practical point of view it makes them much less reliant on make-up, so they can get out the door in the morning without such reliance on covering up, feeling comfortable that skin looks great. Now if that isn’t freedom, I don’t know what is!

Introducing Dr Sam's