5 Questions: Understanding "Melasma"
Summer is coming! Thailand’s intense summer sunlight is the primary culprit behind many skin concerns. One of the most prominent issues, especially for women, is Melasma. Let's get to know this condition and prepare your skin for the summer heat.
Q: What causes Melasma?
A: The primary causes include:
- Genetics: There is a strong correlation between melasma and family history. Some individuals have a genetic predisposition that makes their skin more reactive.
- Sunlight (Ultraviolet): This is the most critical factor. UV rays directly stimulate Melanocytes to produce and distribute pigment, causing dark spots to darken further.
- Hormones: Melasma is clearly linked to hormonal changes, particularly during pregnancy. Women taking oral contraceptives often find their melasma darkening and becoming more resistant to treatment.
Q: Can Melasma be permanently cured?
A: 90% of melasma cases occur in women and are linked to female hormones.
Since it is tied to genetics and hormones, it cannot be “cured” permanently. However, modern dermatological advancements allow us to significantly fade the spots and control them so effectively that the skin appears nearly normal.
Q: Why does my melasma darken even though I use sunscreen?
A: This is usually due to incorrect application or misunderstandings about how sunscreen works.
Effective treatment starts with proper prevention. Since sunlight is the main trigger you can control, you must follow these rules:
- Choose the Right Sunscreen: Look for at least SPF30+ PA++ to protect against both UVB and UVA. For those already suffering from melasma, SPF50+ PA+++ is highly recommended. If you are unsure which type suits your skin, consult a dermatologist.
- Apply the Correct Amount: Many believe a high SPF allows them to apply just a tiny amount. To achieve the SPF/PA rating listed on the bottle, you must apply 2 milligrams per square centimeter—roughly the amount that covers two full fingers for your face.
Referencing Fig 1: A study on Asian skin found that using SPF 35 but reducing the amount by half (to 1 mg/cm²) dropped the actual protection to an SPF of only 5! Application volume is vital.
"This is why we recommend high SPF; even if you under-apply, some level of protection remains."
- Re-application is Key: Sunscreen only protects the skin for about 2–6 hours. For those with melasma, you should re-apply every 2 hours if you are outdoors or near windows.
Q: What are the treatment options for Melasma?
A: Modern medicine offers several effective approaches:
- Topical Creams: Often contain Hydroquinone. This must be used under a doctor's supervision. Incorrect concentrations can lead to permanent white spots (depigmentation) or "rebound" darkening, a common issue with unregulated "miracle creams" sold online.
- Oral Medication: Tranexamic acid has been clinically proven to fade melasma. However, because it affects blood clotting, patients must be evaluated by a dermatologist before starting this treatment.
- Laser and Advanced Treatments:
- Laser Therapy: Specialized lasers like Q-switched Nd:YAG, Copper Bromide, or PicoSure break down excess pigment into tiny particles without thinning the skin, provided they are operated by a specialist.
- Electroporation: Uses ion waves to push medication deeper into the skin than regular creams can reach, often used to boost laser results.
- Chemical Peeling: Using TCA or Fruit Acids to exfoliate. This is less popular today due to the risk of post-inflammatory hyperpigmentation.
Q: When should I start treatment?
A: Melasma usually appears in adulthood. You should start treatment as soon as you notice the first spots.
Early intervention yields much better results than waiting until the patches are deep and widespread.
Important Note: Not every dark spot is melasma.
Facial spots can also be Hori’s Nevus, Freckles, Solar Lentigo, or Seborrheic Keratosis. Each requires a different treatment. An accurate diagnosis by a board-certified dermatologist is the only way to achieve satisfying results.
