“Imperfection is beauty, madness is genius, and it is better to be absolutely ridiculous than absolutely boring.” – Marilyn Monroe.

MELASMA is hormonally induced hyperpigmentation. It is also called the “pregnancy mask” as it tends to occur in pregnancy with the hormonal fluctuations.

New science has been unfolding each year leading to more dramatic results. There are many treatment options for melasma, but the exact aetiology has not been completely determined so it can be quite challenging to treat.

Melasma tends to appear in large dense patches with lines of demarcation. It can also affect other sun-exposed areas such as the forearms. It is more prevalent in women, and is more common in those with darker skin, but can really affect any gender or ethnicity.

The depth of the pigment can be determined by the clinician, and that really determines how long the process will take.

Combination therapy with different kinds of peels tailored to the skin type, depth have been proven to be effective in my expereince. Superficial peels with a combination of acids provide gentle exfoliation without inducing unwanted trauma.

Daily care products should also be used with other products which prevent melanin overproduction, and which decrease inflammation and oxidation.

PIGMENT REDUCING INGREDIENTS

1. Hydroquinone

This is a bleaching agent which decreases melanin formation, but should be used in low percentages to avoid inflammation.

2. Kojic acid

This decreases melanin formation as well in the same way that hydroquinone does.

3. Retinol

This decreases melanin formation and also increases cell turnover to give one that glow. It accelerates the pigment lifting process. It can also be quite irritating, however.

4. Ascorbic acid

The bioavailable form of vitamin C affects the formation of melanin as well, but by a different action from hydroquinone and kojic acid.

5. Lactic acid

This is an alpha-hydroxy acid that increases exfoliation of early melanin filled cells.

6. Mulberry

This decreases melanin formation.

7. Resorcinol

This decreases melanin formation.

Skin care products and chemical peels with these ingredients will be benficial.

1. Mechanical Exfoliation

Microdermabrasion: This has been used with some results. When using this, however, or scrubs generally, over-aggressive exfoliation has to be watched, and treatment-induced discolourations can occur.

2. Laser therapy

Studies have shown that while this method is beneficial for sun-induced hyperpigmentation, it will frequently worsen hormonally induced melasma (post three sessions of combination chemical peels).

In recent years, breakthrough ingredients have enabled us to deal significantly with melasma. UV radiation education has to be emphasised as the most important step we have made in controlling melasma. It is imperative as the UV radiation increases inflammation.

So remember that beauty is in the eye of the beholder, and that beholder is you.

Dr Simone Van-Horne is a consultant in Internal Medicine. Currently, she is a hospitalist where she does inpatient-hospital medicine in Florida, and sees patients in a medical spa setting at Metamorphosis Medispa Wellness Center Inc in Hollywood, Florida, and at The Face Place JA at 3 Carvalho Rd, Kingston, and The Skin Bar, #16 Freeport Shopping Centre, Montego Bay. Contact info@spamorph.com and www.spamorph.com for questions.