PIGMENTATION (MELASMA)

… we may have a solution!

Pigmentation of the face, also known as Melasma or Hyperpigmentation, most commonly first appears: 

  • During pregnancy but unfortunately, doesn’t always disappear after the pregnancy.
  • When taking oral contraceptives but it does not always disappear after ‘the pill’ is stopped.

Then again, there are people in whom it develops without any obvious hormonal explanation and the cause in such cases can remain a mystery.  

Interestingly, the condition is not confined to women – it is occasionally seen in men, especially in those with olive or darker complexions from Southern Europe, the Middle East, India or Asia. In such cases, excessive ultraviolet exposure seems to be the most important factor.

How is it caused? 

In the majority of women, the condition is caused by a combination of oestrogen hormones and ultraviolet light acting on the pigment-producing cells in the skin. Elevated oestrogen hormone levels during pregnancy or when taking oral contraceptives then render the skin’s pigment-producing cells more sensitive to ultraviolet light. When these sensitised cells are then exposed to sunlight, they are stimulated to produce excessive melanin pigment, hence the pigmentation. 

In those women without an obvious hormonal explanation for the pigmentation, as with male sufferers, it would appear that for reasons still unknown, the pigment cells in certain areas become more sensitive to ultraviolet light and start producing more melanin.

Treatment 

Unfortunately, there is no single, established treatment for pigmentation that is successful in every patient. A treatment that gets rid of one person’s pigmentation may not work for another! Accordingly, the treatment of facial pigmentation can prove frustrating for the patient if different methods need to be tried before one proves successful. 

Accordingly, every patient with pigmentation needs to approach the treatment realistically, have patience, accept the possibility of recurrence and the need to then try another method, and most importantly, to be prepared to follow the advice on sun protection conscientiously. 

General Measures 

If possible, stop any oestrogen hormone medications.  Oestrogen sensitises the pigment-producing melanocytes in your skin to produce more melanin, hence the pigmentation.  If you are taking the oral contraceptive pill, you may consider asking your General Practitioner’s advice regarding the Mini-Pill (contains Progesterone only), or an alternative method of contraception.  

Try to avoid sun exposure as much as possible.  When outdoors always wear a wide-brimmed hat and sunglasses and sit in the shade if possible.  NO SUNBAKING, even with sunscreens. Whenever outdoors, even on cloudy days, always wear an effective sunscreen. The reason for this is that ultraviolet light (especially Ultraviolet A) is present all year round, even on cloudy days, and moreover, can easily penetrate glass e.g. when driving a car or sitting at a window. 

The problem is that most conventional sunscreens offer sufficient protection from Ultraviolet B but only partial protection from Ultraviolet A rays.  The best UVA sunscreens are the opaque sunscreens (e.g. zinc cream) or opaque foundations.

Our Special Treatment 
Program for Pigmentation  

Microdermabrasion, when performed to a medical-grade degree on a monthly basis by our Skin Aesthetician AND combined with topical infusions of Skin Lightening Cosmeceuticals, has brought about a number of dramatic and permanent removals of the pigmentation when previous treatments elsewhere have failed!

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Other Treatments 

  • Depigmenting Lotion or Cream for those needing a quick but temporary relief from the pigmentation for an important social event. This can only be supplied by a pharmacy on prescription and accordingly you would need to make an appointment with our doctor to get this. The depigmenting preparation needs to be started at least 6 weeks before your event in order to give it enough time to remove the pigmentation. However, you should not use the depigmenting formula indefinitely as there are potential complications with long-term use. You must also be prepared that the pigmentation, by its very nature, will unfortunately return when the formula is stopped. Accordingly, most patients reserve this temporary treatment option for special occasions. 
    Please note that most commercially-available skin-lightening preparations are only weakly effective for Melasma.
  • A Medium-Depth Chemical Peel can be tried but it does entail 7-8 days’ downtime and more often than not, the pigmentation returns soon thereafter. Although long-standing clearances of pigmentation have been reported after two Medium-Depth Chemical Peels done in quick succession several weeks apart, there is also the risk with this option that the pigmentation could return worse than before!  
  • Pigment-Targeting Lasers, such as the Q-switched Nd:YAG Laser, that specifically target brown pigment, may be worth your consideration but bear in mind that such lasers are not always successful and each treatment can prove quite expensive.   

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