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Melasma: Identification and Treatments

By: Robert Manzo
Posted: January 31, 2014, from the February 2014 issue of Skin Inc. magazine.

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Native freckles and ethnic melanin banding. Native freckles and ethnic melanin banding are genetically linked root causes of hyperpigmentation. Although it is sometimes difficult to distinguish between the two, a trained skin care professional can do this. Melanin banding in skin usually presents itself as smooth, darker areas around the eyes and chin.

Melasma. Melasma, also known as chloasma or pregnancy mask, is a hormone-induced condition. The onset is often consistent with hormone spikes that occur during pregnancy; changes in birth control; shifts in estrogen, estradiol and progesterone; and, in lesser cases, high stress-related life issues. The presence of melasma is marked by symmetrical map-like lesions on the face, typically in the cheek and forehead areas, but often appearing on the upper lip.

There are two primary types of melasma: epidermal melasma and dermal melasma, and they are distinctly different in diagnosis and treatment. Epidermal melasma can be observed in the epidermal tissue and is generally tan-to-brown in color. Dermal melasma is in the dermal tissue and appears gray-to-grayish brown in color. A definitive method to determine the difference between epidermal and dermal melasma is to take photos of the skin with color UV reflectance photography.

Case Study 1. See Case Study 1: UV Imaging. Notice how apparent the melasma becomes when overlaying the two images. It can be seen that this client is exhibiting primarily epidermal melasma. The melasma will appear in the standard and the color UV imaging if it is epidermal, but will not if it is dermal melasma.

Case Study 2. You can see in Image 1 a client presented with two symmetrical hyperpigmented lesions. At first glance, the case could be made for melasma since it presents as a map-like symmetrical pattern, but this is PIH. The history of the client indicated that her sun damage was over-treated with IPL, which caused a significant inflammation response. There were several more interventions with IPL, continually worsening the condition. Upon client referral, image analysis, biometric and colorimetric measurements were taken. It was clear though underlying erythema (redness) measurements, as well as color UV imaging, that PIH was the root cause of this hyperpigmentation. Once this was determinationed, a few decisions were immediately made.

  • No thermal or chemical treatments, such as laser, IPL or peels, should be performed. These modalities would only further inflame the area and worsen the PIH.
  • Exposure to UV light and environmental oxidative factors, such as cigarette smoke, should be strictly avoided and a broad-spectrum SPF 50 should be used daily.
  • A topical regimen, including skin-lightening agents and anti-inflammatories, as well as barrier repair agents, is the preferred course of treatment.

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