Best Melasma Treatments

Melasma is one of the most common and distressing pigmentary disorders the cause lots of grief to British women. The precise cause of melasma remains unknown. However, there are many possible contributing factors. Melasma is characterized with brown, dark brown to grey pigmentation most commonly on face and sometimes on extra-facial areas such as forearm. Although no systemic involvement is known for this condition, it imparts significant psychological stress on the affected individual. Women are more commonly affected right after child birth. Various aggravating and precipitating conditions are known to be related, but none has been proven. Hormonal factors, pregnancy, oral contraceptive pills are frequently reported to be intimately associated. Sun exposure, like all pigmentation, aggravates the intensity of pigmentation.




 Best Melasma Treatments






Melasma is pretty difficult to treat and has a tendency to relapse. The existing and most tried topical therapy is chemical peels with fruit acids (zelaic acid, kojic acid, arbutin, ascorbic acid, glycolic acid), hydroquinone and the triple combination with tretinoin and corticosteroids. Also, lots newer drugs, mostly combinations containing some proprietary molecules and unknown plant extracts, have flooded the market for the management of melasma. This has happened with the background that well-designed studies and thus documented information are lacking on the efficacy, safety, and right dosage on both the age-old drugs that are in use for significantly long time.





Chemical Peels




Chemical peels for treating melasma may be superficial or medium depth peels. Alpha and beta hydroxy peels like glycolic, salicylic, Jessner's Peel, TCA peel , azelaic acid peels have been studied extensively for their therapeutic benefits in resistant melasma. Deeper peels are generally not used for melasma as they are associated with with more complications and longer healing.



Recently, newer chemical peel solutions were found to be useful when it comes to melasma Newer studies, found that lactic peel, pyruvic peel, and tretinoin peel (retinol) are just as effective in removing dark pigmentation associated with melasma.




 Treating Melasma with Chemical Peel






Lactic acid peels are performed with 60% solution every 2-3 weeks. Lactic acid is an AHA derived from sour milk. Most patients respond well to this treatment and show marked improvement. Lactic acid can be a safe, effective and less costly peeling alternative for melasma.


Pyruvic peel is another light peel used in melasma. Pyruvic acid is also a naturally-derived alpha keto acid. For treating melasma, it is used in 40% - 70% solution as a superficial peeling agent. Just as with lactic peel, pyruvic peels are performed every 2 weeks.



Tretinoin peels are based on retinol like compounds. For treatment, 1% tretinoin solution is used once a week. Usually, it takes about 10-12 weeks to see results. These peels are very well tolerated by most people. However, some people experience extra dry skin that requires a lot more moisturizer.

Another potential peeling agent, which has been successfully tried in melasma, is mandelic acid It is an aromatic alpha hydroxy acid (fruit acid). Chemically, it is alpha hydroxy benzene acetic acid. It is extracted from bitter almonds and has an advantage of causing less irritation as its large molecular weight causes slow penetration into the skin. It is available in algae extract gel or lotion base in concentration of 2% - 10% in isolation and also in combination with other topical vitamins C and E. Mandelic peel is applied in concentration of 30% - 50% weekly or biweekly. It can also be used as a face wash (at 2%-5% concentration) in addition to weekly peels. Mandelic peel’s main advantage lies in lower amount of side effects like erythema and crusting.



Lipohydroxy acid is another chemical peel on the market. It is a salicylic acid derivative with an additional fatty acid chain, thereby imparting increased lipophilicity and greater keratolytic effect (it dissolves fatty substances such as sebum). It has good penetration throughout the epidermis but less deeply than salicylic acid or glycolic acid. Also, lipohydroxy peel targets corneosomes and detaches them in the stratum corneum without modifying keratin, resembling normal turn over. Its pH is same as that of skin, hence tolerability is better, and it does not require any neutralization.




So, what to do if you melasma does not respond to chemical peels? Laser can also be a treatment of choice for resistant melasma. Lasers can be used alone as well as in combination with chemical peels to achieve desired synergistic effects in a shorter duration of time even in resistant cases. The combination of lasers and chemical peels can also be beneficial for enhancing the efficacy and patient satisfaction. Studies showing the efficacy of this combination, had patients with complete resolution of their melasma, usually with minimal side-effects. Which lasers can be used on melasma? The best choice is Alexandrite laser, Pulsed CO2 laser, and Q switched Nd Yag.





Melasma after Alexandrite Laser





To conclude, melasma is a very common skin problem faced by lots of women in UK (usually after child birth). While lots of informercials and ads promise to solve this, in reality, this skin condition can only be treated with chemical peels and lasers. Obviously, chemical peels are not as effective as laser. However, they are fairly cheap and can be done at home. Laser treatments work much quicker to resolve melasma, but require visits to a specialists and cost a lot of money. But, if money is not an issue, the best course of action is to combine lasers with chemical peels.








Chemical Peels and Skincare Supplies for UK