What is Melasma?
Melasma is characterised by irregularly-shaped, hyperpigmented patches, predominantly occurring on sun-exposed regions of the skin (e.g. Forehead, Nose, Upper lips, Chin and Cheeks). It can also affect other parts of the body, such as the neck, chest area, forearm. It is one of the most common pigmentary disturbances in female Asian women.
What is the cause?
It is believed to be multifactorial.
- Light/sun/UV exposure
- Hormonal Influences (Pregnancy, Oral Contraceptives, Hormonal Replacement Therapies)
- Family History
Recent studies have shown that it is also associated with an increased of dermal blood vessels.
That is why it is a challenging treatment. Treatment often has to consider that the pigments are situated at many different layers of the skin.
Different modalities of actions are also needed to help address the other contributing factors to melasma. Hence, we often like to combine several therapies: topical, oral and procedures.
What are the treatment options?
Treatments are therefore aimed at various aspects of the pathogenesis of melasma; including sun-damage, inflammation, vascularity, and pigmentation.
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First-line therapy would be sunscreen. Since UV and visible light are the leading cause of flares and exacerbation of melasma, it is essential to avoid the sun’s exposure as much as possible. That means no sunbathing or beach excursions related activities and wearing sunscreen of at least SPF 30 with PA +++ religiously.
For the mild type of melasma, medical-grade topicals may suffice. The topicals for melasma are mainly hydroquinone and tretinoin, but these also come with side effects that may not be the most tolerable. Some of the common side effects include redness, stinging and itching.
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Special effects are SW1’s cosmeceutical product that contains active treatment ingredients that are safe from the irritable side effects. Mequinol is a safer derivative of the well-known hydroquinone, which is made infamous by its detrimental side effects. Regular usage can help lighten the pigmentation in the skin over time.
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This skincare treatment combined with a laser works excellently. Topical tranexamic acid is the most effective amongst other agents vitamin C and vitamin A.
Tranexamic Acid works by reducing melanocyte-stimulating hormone (MSH), and decrease vascular endothelial growth factor VEGF ( which is responsible for blood vessels growth). Some of the known side effects of Tranexamic acid include abdominal bloating, headache, tinnitus, menstrual irregularities, and deep venous thrombosis (DVT).
This supplement contains Polypodium leucotomos (PL) extract, which has been shown in a study conducted by the Singapore National Skin centre to be effective in improving melasma by 62% in 12 weeks. It also contains glutathione that has been proven to decrease melanin and reduce inflammation.
Combination treatment such as topical medication and laser give more effective results.
This is a novel 1,927 nm Fractional Thulium Laser that has been shown to treat melasma very effectively since it targets water and induces a dense array of microscopic tissue injury. It is believed that this pattern of injury-causing “melanin shuttling” and remodelling of the dermis hence reduces pigments more efficiently than the other type of lasers.
This is the latest type of technology with picosecond pulse duration, which means it is firing the laser beam at a trillionth of a second. This superfast pattern of energy firing is said to be the reason for its effectiveness in pulverising stubborn pigment marks in the skin. It is also coined the gold standard for tattoo removal.
What is the downtime?
Depending on the treatment options that you choose. For topical treatment, there should be no issues except for stronger medical-grade treatment. “For BB Aquatouch laser, you can expect a downtime of about 3-5 days since it is a mild ablative laser, it will cause some scabbing and roughness of the skin which will take a few days to slough off naturally” says Dr Mavis Pak, aesthetic doctor. The expected downtime is also consider to be quite acceptable for some people as they find that they can easily cover the scabs with some makeup and attend functions.
As for Pico Pigment laser, there is no downtime as it is a non-ablative laser, the skin is not broken. You can expect some scabbing as the pigmentation falls off and some tiny red spots (pin-point bleeding spots) which is expected.