Treatment of Melasma

Melasma is the English name for the condition, derived from the Greek word melas, meaning black. Usually, these spots are limited to areas of the body and face exposed to sunlight. The spots develop slowly and often appear symmetrically on both sides of the cheeks, as long patches extending down the cheeks, or as small dots. Affected areas include on the nose, like butterflies on either side of the cheeks, on the upper lip, and around the mouth. Many people may have doubts about the treatment of melasma, questioning whether it can be effectively treated or whether promising results can be achieved. In fact, this belief is unfounded.

If proper treatment is administered by identifying the exact cause, significant improvement can be achieved in most cases, especially with certain precautions. However, a good understanding of the disease is essential before starting treatment. Factors causing melasma include pregnancy, contraceptive pills, the use of hormones like estrogen and progesterone, and certain medications. Sun exposure and hereditary factors also play a role in the development of melasma. The prevalence of melasma is relatively higher among females compared to males, influenced by factors like ethnicity, age, and gender. Over 20% of patients report hereditary issues. Evening sun, pregnancy, and sun exposure also increase the likelihood of developing melasma. It is more common in tropical and subtropical regions where sunlight is intense. Melasma may appear in the first and third trimesters of pregnancy, gradually decreasing after delivery but often increasing in subsequent pregnancies.

Melasma can be divided into four categories:

  • Epidermal: These spots are brown, and the color becomes more visible when viewed under a lamp. About 70-75% of patients fall into this category. Treatment at this stage is highly successful.

  • Dermal: These spots are small or large, dark brown or purplish-brown, with little variation in color under a lamp. Around 13% of patients are in this stage. Treatment success is limited.

  • Mixed: The spots are dark brown and appear unchanged in some areas under light. These cases heal slowly with medication, with about 10% of patients falling into this category.

  • Indeterminate: Mostly occurs in individuals with darker skin. Melasma is visible only in natural light and shows no change under a lamp. This stage comprises about 5-6% of cases.

Treatment and Precautions:

Melasma patients are often eager to restore the normal color of their facial skin. Fair to excellent results can be expected with proper treatment. However, the following factors must be considered during treatment:

  1. Melasma is not a serious disease, and patients can be reassured about this.
  2. These spots are treatable, and good results can be achieved if patients cooperate fully with their doctor.
  3. Patients should be aware that sun exposure and hormonal changes can worsen the condition.
  4. Discontinue the use of contraceptives.
  5. Avoid using cosmetics that are not well tolerated by facial skin.
  6. Avoid exposure to strong sunlight, especially between 10 a.m. and 4 p.m. If going outside is necessary, use an umbrella or wear a hat and sunglasses.
  7. Apply sunscreen at least half an hour before sun exposure.

Medications Used in the Treatment of Melasma:

  • Hydroquinone Acid Cream (2% – 5%)
  • Retinoic Acid Cream (0.05% – 0.1%)
  • Sunscreen Cream

These treatments can produce excellent results within 6-12 weeks when used as prescribed. However, dosage, duration, and follow-up of all medications should be under the supervision of a dermatologist.