How to treat melasma, according to two skin experts

3 months ago 35
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Indian skin is prone to hyperpigmentation, which causes dark brown spots, freckles, or dark patches to appear on the skin. This discolouration is caused due to excess deposits of melanin, the pigment which lends colour to our skin and hair, and can happen due to sun exposure, hormonal fluctuations, trauma, heat, genetics and post-inflammatory hyperpigmentation. “As Indians living in the tropics, one of the main skin concerns we face is pigmentation and tanning. We tend to wrinkle lesser than our western counterparts, instead, we pigment heavily,” says Dr Harshna Bijlani, medical head, The AgeLess Clinic, Mumbai.

What is melasma and what does it look like?

One of the most difficult-to-treat versions of hyperpigmentation is melasma. Melasma is seen in the form of light to dark brown patches with ill-defined margins. Also called the butterfly rash, it starts with appearing below the eyes, goes to the nose, and gradually some people develop it on the eyebrow, upper lip, and is extended all over the cheek. Epidermal melasma forms in the upper layers of the skin and is easier to treat as it is superficial. In dermal melasma, the pigment has migrated down to the deeper dermis. “Melasma commonly occurs due to sun exposure, genetics and hormonal imbalances in the body. Not everyone in the sun gets melasma too and a person can get melasma without sun exposure if they have a strong genetic predisposition,” says celebrity cosmetic dermatologist, Dr Jaishree Sharad.  

While you can be extra careful with your sunscreen and try and avoid melasma if you have a predisposition, hormonal imbalance is what makes it more difficult to treat melasma. It is common among pregnant women and those who use oral contraceptives because of the oestrogen-progesterone alteration. “For many, it goes away post-pregnancy. For those with a genetic tendency, it may persist. Sometimes it can fade on its own, which is seen around menopause as oestrogen level decreases,” says Dr Sharad about the influence of hormones on the condition. Stress too can trigger or worsen melasma, and it can be more prominent just before your period when progesterone is high. 

How can you safely treat melasma at home and in-office?

A common concern is self-medication with steroidal lightening creams, rues Dr Sharad. “The most popular treatment is a triple-combination which is retinol, hydroquinone and steroid cortisone, which is available with a prescription. But when people self-medicate, you don’t know how long to use and stop. This causes side effects as one can’t use steroids for a long period,” she adds. “Overuse of these creams causes thin skin, blood vessels and spider veins, acne, sensitive skin and hair growth on the face. Long-term use of hydroquinone causes ochronosis, which is a severe form of hyperpigmentation."

Dr Sharad suggests using products with Vitamin c, arbutin, kojic acid, AHAs, turmeric, liquorice or tranexamic acid while doubling down on sunscreen. She also suggests treatments like microneedling and peels. “Laser treatments can be risky and don’t always work with melasma as it comes back. I don’t treat melasma with lasers, except when people are looking for a temporary quick fix,” she confirms. 

Also read:

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What you need to know about treating hyperpigmentation on Indian skin

From acne to hair removal: How laser can be a part of your pre-wedding skincare

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