Melasma and Hyperpigmentation

Melasma & Skin Discoloration

Dark patches, also known by the scientific term “melasma”, and skin discoloration in general are very common and particularly significant concerns for facial aesthetics. They mainly affect women of reproductive age, although they may also appear in men, while the problem certainly becomes more pronounced over the years.
According to international statistics, approximately 60 million people develop melasma, 90% of whom are women.

Dark Patches or Melasma: What Are They?

Melasma consists of areas of skin discoloration that often resemble “patches” and make the skin appear stained. They have a brownish or generally dark color, which may even be black, and are most commonly located on the forehead, cheeks, upper lip and chin. In most cases, their shape is irregular and poorly defined.

Dark Patches or Melasma: Are They Dangerous?

The problem associated with melasma is purely aesthetic. It is not essentially a disease, meaning that the skin is not unhealthy and its appearance is not associated with an illness. It is caused by dysfunction of cells on the surface of the skin called melanocytes, which are responsible for producing melanin.

What Is Melanin?

Melanin is a family of skin pigments and has three main types:

1. eumelanin,
2. pheomelanin, and
3. neuromelanin.

Melanin is produced by specialized cells of the epidermis called melanocytes. The higher the levels of melanin in the body, the darker the skin color. The role of melanin is to protect the skin from harmful solar radiation. Melanin is therefore a very useful substance for the body, as it protects us from sunburn, photoaging and skin cancer. However, any abnormality in the function of melanocytes, and consequently in melanin production, results in the appearance of melasma, spots and skin discoloration that alter the normal appearance of our skin.

Causes of Dark Patches – Melasma

The causes of melasma are generally unknown. However, we now know that two main factors contribute to its development:

• heredity, and
• sun exposure.

Melasma appears more frequently on the face because this area is continuously exposed to the sun more than any other part of the body. It may also appear on the body in individuals with a strong genetic predisposition, particularly during the summer months. During summer, due to intense sunlight, the patches become more pronounced, while during winter they subside and become less visible.

In general, the main causes of melasma are:

• chronic sun exposure
• pregnancy and changes in hormone levels, including estrogen and progesterone
• hereditary predisposition
• the use of certain medications or products that increase photosensitivity, such as contraceptives, corticosteroids, antiepileptic medication, etc.
• poor nutrition that is low in fruit and vegetables and is often associated with deficiencies in iron, magnesium or vitamin C
• gender, as it predominantly appears in women
• skin infections
• liver problems
• skin dehydration
• burns
• the use of certain scented soaps and cosmetics
• stress.

Skin color is also important, as melasma tends to “prefer” darker skin tones. If there is a genetic predisposition to melasma, the condition may become more pronounced or develop more rapidly when certain hormonal factors are present, such as when a woman takes contraceptive pills.

Pregnant women, usually during the second trimester of pregnancy, may develop melasma, which in this case is called “chloasma” or the “mask of pregnancy”. This condition is triggered by pregnancy hormones and, in most cases, subsides a few months after childbirth.
If it remains 5-7 months after childbirth, it may persist with periods of flare-ups and remission for many years. If there is a second or third pregnancy, the chloasma usually becomes even more severe and deeper.

Types of Dark Patches – Melasma

Depending on their depth and the particular characteristics of the lesion, dark patches and melasma are divided into four types:

1. Epidermal: the lesion is located superficially, has a brown color and appears because excess melanin is located only in the superficial layers of the skin. This type responds extremely well to available treatments.
2. Dermal: the lesion extends deeper, has poorly defined borders and appears very dark in color. This type responds moderately to available treatments.
3. Mixed: the lesion is located at an intermediate depth, has poorly defined borders, is dark brown and combines the epidermal and dermal types. This type responds less effectively to available treatments and is unfortunately the most commonly occurring type of melasma.
4. Indeterminate type: this lesion is more common in darker skin tones.

Melasma is a chronic condition with periodic remissions and flare-ups, which usually worsens during the summer months.

In most cases, the reduced sunlight during winter leads to the regression of melasma and an improvement in its clinical appearance.

Just as the development of melasma is a slow process, treatment also appears to require time before producing results. The gradual fading of dark patches depends on the correct treatment plan, which differs for each skin type and always depends on the cause that triggered them.

Protection and Treatment

Preventing pigmentation disorders is generally quite difficult and requires considerable care and discipline. Nevertheless, avoiding sun exposure may delay or, in rare cases, prevent the appearance of melasma. In every case, the use of sunscreen products with a high protection factor is recommended, with SPF>30 for the body or SPF>50 for the face. Once melasma appears, its treatment and the results of each therapy depend on the type of melasma and the quality of the skin.

Treatment of Melasma and Dark Spots

As previously mentioned, a key factor in treating skin discoloration is the correct diagnosis and identification of the cause that triggered it.
Today, both melasma and dark spots can be treated effectively thanks to modern Aesthetic Medicine and its advanced treatments. A specialized Plastic Surgeon or dermatologist is the appropriate professional to recommend the treatment plan that will address the specific problem.

The best period for treating dark patches and melasma is during autumn and winter. In other words, to avoid side effects and treatment failures when addressing hyperpigmentation, the relevant treatments should not be performed during spring and should never be performed during summer, when sunlight is intense.
If someone undergoes treatment for melasma at the end of spring or during summer, they risk not only seeing no improvement, but also experiencing a worsening of the condition, making it more difficult to correct.

Depending on their type, dark patches and spots can today be effectively treated using the following methods:

-Fractional Laser

Most pigmentation disorders occur due to melanin deposits and, in these cases, they can be lightened using specialized Laser devices. The Lasers, meaning Light Amplification by Stimulated Emission of Radiation, used to treat pigmented lesions are numerous. The main parameters for selecting the appropriate Laser are: (a) the type of pigment, whether endogenous or exogenous, (b) its location, whether in the epidermis or dermis, and (c) its distribution, whether intracellular or extracellular.
The most modern and effective method for treating melasma and dark spots today is the application of Fractional Laser or pigmentation-removal Lasers, such as the Erbium glass Laser.

The light emitted by the Laser penetrates only a few millimeters into the skin and does not harm the rest of the body or underlying organs. The treatment is based on selective destruction using microbeams that penetrate the epidermis in fractions, leaving areas of healthy tissue intact and therefore accelerating the healing process.

With fractional technology Lasers, the Plastic Surgeon can act in an entirely controlled manner and at a specific depth, treating the problem at its source without affecting the adjacent healthy skin tissues.
Before and after every session, sun exposure must be avoided and, as always, sun protection should be used.
After treatment, mild irritation may occur in the area, which gradually subsides within the following 1-2 days. In most cases, combination treatment with medicated bleaching creams is necessary. These creams are used both as preparation and during the intervals between Laser sessions.

It is important to know the following regarding the treatment of spots and melasma with Fractional Laser:

• Sun exposure should be avoided for 4-6 weeks before and after treatment, as well as throughout the treatment period.
• Treated pigmented lesions subside after treatment but may recur following renewed exposure to intense sunlight.
• Laser treatment does not prevent the development of new “brown spots”.
• A large percentage of superficial lesions will disappear after the first sessions, while some more persistent lesions may require several repeat treatments.
• Many cases of melasma, particularly those of the mixed type, respond poorly to treatment.

-Diamond Microdermabrasion (Diamond Peel)

Diamond Microdermabrasion achieves exfoliation and regeneration of the epidermis, resulting in a fairly satisfactory treatment of melasma and dark spots.
Diamond peel treatment removes the outer layer of the epidermis without bleeding, along with damaged and dead cells and areas of hyperkeratosis.
Diamond microdermabrasion is a simple and painless treatment that allows an immediate return to work without requiring recovery time. It leaves the skin visibly cleaner and healthier and has significant regenerative properties.
Several repeat sessions are required to achieve a satisfactory result. It is often applied in combination with Laser treatments and bleaching creams.

-Chemical Peeling

When Chemical Peeling is applied for the treatment of melasma and dark spots, chemical solutions with exfoliating action and strong lightening properties are used. These treatments are performed in the clinic and usually more than one treatment is required to achieve an appropriate result. The substances used to exfoliate the epidermis depend on the skin type and the type of lesion.

-Topical Treatments and Bleaching Creams

The application of topical bleaching products is planned by the doctor and applied by the patient at home for a specific period of time.
The active substances commonly used for skin lightening include hydroquinone, vitamin C, corticosteroids, azelaic acid, retinoic acid, kojic acid, tretinoin, etc. In most cases, these substances are mixed together in different concentrations, creating customized bleaching formulas that are extremely active.

The cream is usually applied locally to the areas where melasma appears, only during the evening, and for an extended period of 3-4 months during autumn or winter.
Treatment with Bleaching Creams may be combined with Microdermabrasion and Fractional Laser for a more comprehensive result.

It is generally considered a relatively safe solution, as it gradually lightens melasma and spots until they are no longer as visible. As already mentioned, it should be avoided during summer.

Dark Patches – Melasma: Can I Undergo Treatment During Pregnancy or Breastfeeding?

During pregnancy or breastfeeding, we do not recommend any treatment that affects deeper tissues, such as Laser treatments, bleaching creams or chemical peels, since the use of substances that penetrate deeper into the skin could cause problems.
The only treatment that may be applied during pregnancy or breastfeeding is Diamond Microdermabrasion.

Basic Prevention Rules

• In general, it is essential to use sunscreen with a high protection factor throughout the year and on all areas of the body and face that are exposed to the sun. Sunscreen should always be applied approximately 30 minutes before going out into the sun, not only when going swimming at the sea or pool. Sunscreen should be reapplied every 2-3 hours.
• For individuals with severe melasma, we recommend completely avoiding sun exposure and using hats, sunglasses, long-sleeved clothing and even an umbrella during periods of intense sunlight.
• Make-up products containing sun protection provide additional prevention and greater convenience in everyday life.
• If the development of melasma is associated with taking or applying certain medications, it is advisable to discontinue them, provided that doing so does not adversely affect our health.
• Certain scented soaps and cosmetics, such as deodorants, may be responsible for the appearance of spots and melasma. Therefore, caution and immediate discontinuation of their use are required if we determine that they have caused a problem.

Dark patches, melasma, spots and skin discoloration in general represent an important subject within facial and body aesthetics. They are conditions for which modern Aesthetic Medicine and Plastic Surgery seek and provide effective solutions.