One common concern individuals with darker skin face is tanning with exposure to UV radiation from the sun. While this is much sought after by people with fair skin, it is not well perceived by brown skin individuals who often desire a tan-free complexion.
why does tanning occur?
Tanning can be of various types and while the exact mechanisms of how tanning occurs still remains elusive, the various types of pigmentary response to UVR exposure seems to have a different underlying reason as to how it happens.
Immediate Pigment Darkening:
This happens within minutes of sun exposure. UVA radiation from the sun causes a chemical reaction ( photo-oxidation) of the pre-melanin pigment present in the melanocytes (pigment producing cells) in our skin.
Persistent Pigment Darkening
This occurs with UVB exposure and is thought to be due to increase activity in the melanocytes which then produces more melanin. The dendrites (finger-like projections of the cells) of the melanocytes extend and branch out more into the surrounding skin-cells (keratinocytes) to transfer their melanosomes (organelles where the melanin pigment is formed and stored) into these cells thus causing the increase visible pigmentation on the skin.
what about a tan that last for months?
For most individuals, once exposure to UVR is discontinued, a skin tan will fade in a few weeks. However, for some a skin tan can last for months even with cessation of sun exposure. This have been recently described in the litterature as “Long-lasting pigmentation”.
Such long-lasting pigmentation could be explain by the following reasons:
How to fade a skin tan?
As discussed earlier, most often a skin tan fades spontaneously after a few weeks. For persistent skin tan addressing the possible reasons for the increase pigmentation could help speed up the fading process.
Strict sun protection: Skin tanning will continue to occur if there is continued sun exposure. Hence, it is important to follow sun protection measures in the form of either sun protective clothing or regularly using a broad spectrum sunscreen. For sunscreen recommendations, check out my amazon storefront (for Indian options) and my Shop my shelf (for International options).
Exfoliating agents: Products formulated with exfoliating acids such as glycolic acid, lactic acid etc can aid in the shedding of the upper layer of the skin. For body tan, opt for lotion formulation. I advised against using products with high concentrations of such acids that are often formulated for use over smaller areas such as the face for the entire body. For a more detailed post on “exfoliating agents“, head to my earlier blog post on “Acids in Skincare”
Addressing increase melanocytic activity: Products that help to target pigmentation by by inhibiting the enzyme “tyrosinase” can also help fade a tan faster. Again, if the goal is to fade a tan on larger areas such as legs or arms, lotion formulations are the best.
Glutathione (GSH) either as oral supplements or IV drips as skin lightening agents are the go-to treatments for glowing and bright skin especially in Asian countries and India, where the quest for fair skin is a never ending journey.
In this post we will see what glutathione is? Does it work as a skin lightening agent ? Are there any studies to back up its use in beauty spas or clinics? Is it safe? And is it worth it?
The evidence for oral or topical glutathione for skin lightening is still not convincing yet to warrant a unanimous recommendation for skin lightening or as a treatment for pigmentation
Is there a way to naturally increase GSH stores in our body?
YES you can.
The most economical & sustainable way to prevent glutathione depletion in our body is by preventing the need for GSH in the body in the first place by reducing oxidative stress.
Lifestyle habits that one can make to reduce oxidative stress :
Limit alcohol consumption
Quit smoking
Diet rich in fruits, vegetables and nuts which delivers amino acids required for GSH production or rich in other antioxidants : Tomatoes, oranges, spinach, asparagus, avocado, berries, walnuts, almonds ( best consumed raw or lightly steamed)
Whey protein is a good source of cysteine (an amino acid essential for GSH synthesis)
Pregnancy, one of the most beautiful journey for a women, but it can be associated with many skin changes that can be bothersome and add unnecessary stress during this time.
These changes in the skin, hair or nails are normal and expected, but the good news is, they are temporary and resolve spontaneously post delivery to a great extent even if not completely to a pre pregnant state. Let’s look at what these changes can be and how you can address them.
Hyperpigmentation
This one of the most common change that can see seen in upto 90% of pregnant women. It is more pronounced in women with brown to darker skin type. Body folds, or areas of the body which are normally pigmented such as the under arms, inner thighs, become more pigmented. For some women, diffuse hyperpigmentation can occur.
Such pigmentation does not require any treatment but if one is concern and wants to address it then one can use some product such as lotions, toners etc. Be careful not to overuse AHA’s (gycolic acid) the the underarm areas.
Melasma
Another common pigmentation issue that develops during pregnancy.
Which skincare are safe to use during pregnancy?
Most skincare, be it moisturisers or serums or sunscreens (chemical or physical) can be used safely during pregnancy.
Experts often recommended limiting the amount of exposure to or avoiding certain ingredients as a precautionary measure and not because the ingredient is harmful to the mother or the developing baby.
Hydroquinone (HQ) can be substantially absorbed into the blood stream when applied topically to the skin. Even though there have never been reports of it causing any adverse effects to the baby when used during pregnancy. It is still recommended to limit one’s exposure to HQ or avoid it during pregnancy.
Retinoids are recommended to be avoided during pregnancy based on the evidence that Oral vitamin A analogues when taken orally during pregnancy can cause birth defects in the developing baby. And as topical retinoids are also vitamin A derivatives, it’s recommended to avoid using them during pregnancy if possible just as a precautionary measure. There is no evidence to suggest that one needs to discontinue topical retinoids if one is trying to conceive.
If you are conflicted with making a decision on whether to avoid such ingredients or continue using them in you routine during pregnancy, it’s best to discuss this with your treating dermatologist and gynaecologist who can help guide you make the decision that is best suited for you individually.
Stretch marks
When it comes to preventing pregnancy stretch marks or reducing their appearance, there are not much options out there and most products available in the market that promises otherwise do not work.
The use of products containing cantella asiatica or silicones or hyaluronic acid have some weak evidence that they may help with the appearance of the stretch marks when applied regularly. However these are not miracle creams, you may still develop stretch marks despite using such products regularly.
If you want to try such products, go ahead, just make sure to spend some time massaging the products into your skin as the increase blood circulation to the skin as a result of the massage may be able to help to some extent and set realistic expectations so that you do not get disappointed.
Oils such as rosemary oil, olive oil, cocoa butter, shea butter have never been proven to help.
We’ve all heard of acids such as glycolic acids, and if you’re acne prone- salicylic acid and the rest. These acids are used in skincare products as chemical exfoliants i.e they help to chemically detach cells in the upper most layer of the skin from one another, yielding a more youthful, smoother, brighter skin.
What are the various types of acids used in skincare ?
How do they work?
Lower strength acids as found in OTC cosmetics (usually <10%) works at the level of the epidermis specifically at the stratum corneum (upper most layer of skin) and causes exfoliation.
Higher strength acids (>20%) are used as in-office procedures by professionals as chemical peels. Higher strength and lower molecular size acids such as glycolic acid can penetrate deep into the skin (upto the dermis) to boost collagen, GAG’s production thereby increasing the thickness of skin, and reversing signs of photoageing such as wrinkles, deep lines, sun spots etc.
Concept behind exfoliation
As we age our skin cell turn over (cells from the lower layer, divide and mature and are eventually shed off) slows down. As a results more cells from the startum corneum accumulate on the surface which gives aged skin a more dull, and rough appearance. Chemical exfoliation using acids helps speed up the process of shedding the upper layers of the skin. Hence, incorporating acids in our skin care are of benefit a we age and and for addressing certain skin concerns. They are un-necessary for younger age groups as their skin can naturally exfoliate at a good rate.
Rough estimate on the average skin cell turnover with various age groups
Acids beyond exfoliation
Uses of acids in skin care products can be more than just for exfoliation. Different acids have a slightly unique properties that help address specific concerns.
How to choose a chemical exfoliant?
Firstly, not everyone needs a chemical exfoliant in their routine. If you do not have any skin concerns, or if you are happy if your existing routine, continue what works for you regardless of whether you have such acids or not in your routine.
Amongst AHAs :
Glycolic acid is most commonly used and widely available in skincare products. However being of smaller molecular size, it can penetrate the deeper layers of the skin and cause irritation for some.Â
Lactic acid: another common AHA, but has additional properties of being able to retain water thus hydrating the skin. It’s also less irritating as compared to GAÂ
Mandelic acid : a larger molecular weight AHA that is great for people not tolerating other acids or for people with sensitive skin as it is least irritating.Â
PHA and PBHAs, the newer generation acids. Not only do they provide gentle chemical exfoliation, some PBHAs such as lactonionic acid help hydrate and soothe the skin.Â
Note: The tolerability of such acids are also dependent on the overall formulations. Some products have a combination of these acids for maximum benefit and least irritation. Most often you only require a single product, and try not to use too many chemical exfoliants in your skin care routine without a professional consultation.Â
Irritation is the most common side effect of using such products. It can present as redness, burning or itching. It can also be seen as bumps resembling acne. Start by using such products just once-twice a week instead of every night and do not forget your sunscreen.
Some people may be allergic to certain acids, always perform a patch test prior to using such products especially if you have sensitive skin.
Over exfoliation can disrupt your skin barrier, making it sensitive, dry and irritated. In this case, stop using such chemical exfoliants and jut stick to the basics: cleanser, moisturiser and sunscreen.
If you already have a routine for your acne or pigmentation, please consult your dermatologist prior to incorporating such products in your routine.
Dark circles though very common, can be difficult to address. Many factors are involved in causing dark circles, such as ethnicity, bone structure, anatomy of the skin etc, and most times a cream or serum cannot address all the factors involved, thus resulting in failure of treatment.
Let’s try to understand more about dark circles here.
What causes dark circles ?
There can be intrinsic factors (internal, genetically predetermined factors, inevitable) or extrinsic factors (external, environmental impact, modifiable).
These factors are non modifiable and most topical products such creams/serums cannot completely address these factors
Extrinsic factors can be modified to reduce the risk of developing or worsening of dark circles
Types of dark circles
Understanding the type of dark circles helps guide the treatment options.
So you have been using eye creams religiously for a long time and you still have not seen results. Why isn’t t it working for you?
Lack of sun protection: The under eye area is a commonly missed site during sunscreen application.
Not making the necessary lifestyle changes: Ongoing stress, lack of sleep, not cutting down on smoking and alcohol.
Underlying cause not addressed: Continuous scratching from eczema irritation.
Lack of patience: Depigmenting creams take time to work
Incorrect choice of product or treatment: Some form of dark circles benefit more from prescription medications or from a combination of products + in office procedures such as fillers, chemical peels etc
Unrealistic expectation: No creams/serum can 100% reduce dark circles. Shadowing effect due to bone structure cannot be corrected by creams. Constitutional pigmentation respond only minimally to OTC products.
Oily skin medically done as a “Seborrhoea”is described for skin that feels greasy, looks shiny usually, have large open pores which is also prone to acne and though viewed as a cosmetic concern, what is skin can have a negative impact on one’s confidence and mental health.
Oily skin is such a common concern for many that the beauty and skincare industry are constantly preying on this concern launching products with highly unrealistic claims and marketing strategies with labels such as “oil free’ , “oil control” etc while hero-ing ingredients that have never actually been proven to help regulate oil production at all.
This post will hopefully help you understand more about what oily skin means: that anatomy, physiology, the function of sebum (oil) in skin, why one has more oiler skin than other with a mention on products that can actually work help reduce skin oiliness.
More about sebaceous glands and sebum
What causes oily skin?
There are many factors that contribute to oily skin.
Can oily skin be treated ?
Though oily skin cannot be completely cured, there are certain treatment options that could help control the skin as well as some causes a suitable that is over-the-counter products that may be able to help with its appearance.
Seek professional treatment from a dermatologist if you only skin is really affecting your self-confidence and your mental health or if over the counter products fail to achieve the desired results. A professional consultation will also help rule out certain medical conditions, which would otherwise require further investigation and treatment
Look out for these ingredients in over the counter products :
Salicylic acid, Niacinamide, Green tea extract, L-carnitine
Though these ingredients do not have a very solid scientific data, there are some small scale studies that have shown that they can help address oily skin
I got a few questions on how to store skincare products when one is living in a hot tropical country with summers of >35°C and when instructions on product labels read “store below 25°C or store sunscreen below 30°C?
This is actually a great question and concern for consumers, I was so impressed at this level of consciousness and curiosity when it comes to skincare and cosmetics.
Since I am not a skincare or cosmetic developer, I am not fully aware of the best answer for this question and so I took the liberty to ask for help from a pharmacist and a post graduate in advanced cosmetology: Catarina Cabeçadas to answer this question. She is also the writer of “The skin balance blog“
Do you often get your breakouts just before one event? Have you ever used Pimple patches? What is these patches made of? Do they even work? Can they work for all types of pimples?
What are pimple patches?
These patches are hydrocolloid dressings which were traditionally used for treating acute or chronic wounds. They’ve also been used for the management of post surgical wounds.
Hydrocolloid are hydrophilic (water loving) substance composed of gelatin, pectin, carboxy-methylcellulose. As these substances are attracted to water, they are they can absorb water, and pus from the wounds and then forms a gel which provides a moist environment for the wound.
How do hydrocolloid help in wound healing?
How do hydrocolloid dressings work for acne?
Which type of acne are they best used for?
Single or limited acne
Perfect as an SOS solution for those pimple that always pop up before an event.
Acne which is inflamed (red, painful, with or without pus)
Pimple patches are not ideal for severe, cystic acne.
How to use pimple patches?
Wash face clean before application
Apply the patches over the acne on dry, clean skin
The patches can be left overnight or longer (12-48hrs)
Dispose used patches. Do not reuse them
Skip using face serums, moisturisers oven the active acne before applying the patches
The patches are transparent so they be used during the day.
These patches do not replace the regular acne medications such as benzoyl peroxide, adapalene etc. They serve as rescue treatment for those once in a while acne breakouts.
Are there any concerns regarding these patches?
Well as great as they seem in theory as the emergency acne rescue option, there have not been much research done for their use in acne. I would love to see more studies comparing these to spot application with benzoyl peroxide or salicylic acid.
Some individuals may even be allergic to either the adhesives used in these patches or other ingredients.
So in conclusion:
If spot application of benzoyl peroxide works for you, continue it. There is no need to buy spend extra money on these patches. But if your skin gets too irritated or dry with actives such as benzoyl peroxide or salicylic acid, or you’re the type that just can’t control picking on your acne, then these patches could be a great option for you.
Pimple patches available in the Indian market
Pimple patches are available as either pre cut patches or as single sheets for a customisable size. One can make heat shapes or star shapes or whichever fun shapes out of these sheets.
Some pimple patches also contains active anti acne ingredients such as salicylic acid, tea tree or cantella asiatica which helps in calming and soothing the skin.
These are available at either amazon or on flipkart
The quest for youth and beauty dates back to centuries ago when Cleopatra allegedly bathed in donkey milk (contains high amount of lactic acid which is an alpha hydroxy acid -AHA) to maintain a youthful clear skin. Cleopatra was not alone in this, the Greeks and French were also using sour milk (lactic acid) and fermented grapes (tartaric acid) for their skin.
Elisabeth Taylor as the beautiful Cleopatra
These ladies were not wrong in doing so! These centuries old beauty regimes have paved the way for modern anti ageing, and anti pigmentation beauty treatments.
So what does the 21st century beauty treatment look like?
The same concept of using sour milk etc to chemically exfoliate the upper dead layers of your skin is now being performed by dermatologists all over the world as an office based treatment called “chemical peel”.
There are various beauty treatment options available now, from creams, to LASER’s, to botox, fillers and chemical peels being one of them.
What is chemical peel?
Chemical peels are well controlled cosmetic procedures where a chemical with keratolytic property (able to exfoliate the skin cells -keratinocytes) is applied to the face with the aim of accelerating the natural exfoliation process wherein the superficial dead damaged skin is removed thereby improving the texture of skin, the appearance of fine wrinkles and decreases pigmentation.
In layman terms, chemical peels are cosmetic procedures that uses chemicals to peel off the dead layer of the skin.
The depth of such an effect will depend on the type of chemical used and the concentration of the substance ( eg. Glycolic acid- GA 10-30% is a very superficial peel i.e works in the upper epidermis while GA > 30-70% is a superficial peel effecting the lower epidermis and >70% is a medium peel reaching the dermis).
How does chemical peel work?
The skin has 3 layers : epidermis (uppermost) , dermis (middle) & sunbcutaneous fat (lowermost). The epidermis itself is divided into 4 layers (basal layer, stratum spinosum, stratum granulosum and the statum corneum.
The cells in our skin undergoes a process of multiplication and differentiation (change in shape, structure and biochemical composition) in which cells in the lowermost epidermis change their shape and composition as they move up to the uppermost layer and are eventually shed off.
This is called “skin cell turnover” which normally takes 28-40 days. This turnover is faster in babies and children and slows down with age.
As the cell turnover slows down, the dead skin cells in the uppermost layer of the skin do not get renewed but accumulates and gives the skin a dull, dry and aged appearance.
Ingredients such as alpha hydroxy acids (glycolic acid, lactic acid, mandelic acid etc) disrupts enzymes in the skin that hold the cells together. They can therefore cause the superficial layer of the skin to exfoliate and induce new cell replacement.
At higher concentration, these acids can penetrate deeper into the dermis and stimulate the fibroblast (cells that make collagen) to produce more collagen, elastin and substance that add structure to the skin (GAG’s) thus improves skin thickness and hydration.
Tricholoroacetic acid (TCA) works by causing destruction of the cells by protein denaturation. This then stimulates new wound healing.
Overall benefits that can be achieved with chemical peels
Improves skin texture
Can even out skin tone
Spot peels can be used to treated selected hyper-pigmented areas
Salicyclic peels are used as an adjunctive treatment for acne
Improves the appearance of aged skin.
Melasma after medium depth peel (Jessner’s solution) Image : Rooks textbook of dermatology
Acne scars after medium depth chemical peel. Image : Rooks textbook of dermatology
Procedure of a chemical peel
Chemical peels are not meant to work just on their own. One has to be motivated to follow a strict skin care plan for the maximum benefits from such a procedure.
A dermatologist will take a detailed history and clinical examination to assess if a patient is a good candidate for chemical peels.
A patient will be counselled on the skin care measures that needs to followed prior and after the procedure as well as about the expectations from this cosmetic procedure.
A process called “priming” which is done to thin out the epidermis so as the acids used in the chemical peel can penetrate the layers of the skin evenly. This step involves daily application of creams containing either retinoids/ azaelic acid/ kojic acid etc for at least 2-4 weeks prior the chemical peel procedure.
Sunscreens is an absolute must before and after the procedure.
A dermatologist may do a test peel behind the ear or other areas just to check if a patient is allergic to any of the ingredient or to assess for potential side effects.
Chemical peels are done in an office based setting once in a 3-4 weeks for 6-7 sessions depending on a patient’s response. The chosen acid is applied to the entire face or target area using a brush after degreasing the face. The peels are left for a certain contact time which is increased every session ( for eg, for the first session the contact time maybe 2 min which is then increased by a minute or two every successive session).
Post peel care
This step is just as important as the actual peel procedure.
Cold compression using ice packs if there is any redness after the prcedure.
Strict sun protection using broad spectrum sunscreens.
Use mild cleansers or soap free cleansers for washing the face.
Use a moisturiser at least twice daily to help reduce the peeling of the skin.
Avoid facial waxing, threading, facials and skin bleaching procedures for at least 1 week after the procedure.
Avoid scratching, picking or peeling of the skin.
Complications
Chemical peels are not free form side effects, that’s why pre procedure counselling and right patient selection is very important.
The possible side effects are :
Persistent redness of skin
Post inflammatory hyper or hypo-pigmentation (i.e dark or light spots)
Scarring
Excessive peeling of skin
Scabbing
Allergic reactions.
Scabbing.
Chemical burns (left) and post inflammatory hyperpigmentation (right) as complications of chemical peel. Image : Rooks textbook of dermatology
Chemical peels are add on cosmetic procedures that can be used for various indications. The effects can be impressive when done by an experienced dermatologist and when a patient is compliant with the pre and post peel skin care.
Never try to attempt a self chemical peel at home with products that can be bought online because the side effects could be permanent if sub optimal products are used and with inexperienced hands.
As I was growing up I’ve seen my mum and most of my aunts trying in vain every remedy available for the pigmentation on their face
What is melasma?
Melasma also called cloasma is a common acquired hyperpigmentation disorder affecting mostly women in their reproductive age groups (~15-45 years) . It is the most common pigmentation disorder & is seen more commonly especially in individuals with darker skin type (FST IV-VI) affecting 9 -50% of the such high risk population . (Find out your skin type here)
What causes melasma?
Cause of melasma is multifactorial and factors such as UV radiation, elevated estrogen (female hormones) level work together to result in melasma in genetically predisposed individuals
Genetics: Certain genes are responsible for up regulating enzymes in the melanogenesis pathway (process of melanin production) which results in more melanin production.
UV Rays: Increase production of reactive oxygen species, which can then increase tyrosinaseactivity.
Hormones: Estrogen can up regulate enzymes (tyrosinase) and genes in the melanogenesis pathway, resulting in increase pigment production in genetically predisposed individulas.
How does it present?
Melasma presents with tan brown reticulate (lacy) pigmentation described in three distinct pattern on the face.
Centro facial pattern: Most common pattern affecting the forehead, nose, upper lip, chin and cheeks
Malar pattern : As seen in the below images affects the malar area (cheeks) of face
Mandibular pattern: Affects the jawline and chin, mostly seen in late onset melasma
Melasma in women can present for the first time in pregnancy and its referred to as “Mask of Pregnancy“. Treatment of which is more difficult because of the increase estrogen level in the body and as most medications used for pigmentation may not be safe during pregnancy.
The good news is that in some women, this mask of pregnancy is transient and will fade with time and proper management.
Can melasma occur in males?
Yes, melasma can occur in males as well. The male to female is ratio 1:9 i.e for every 9 females with melasma, 1 male individual also suffers from melasma. It has also been reported to have a higher prevalence in Indian males compared to Caucasian males.
Does melasma occur elsewhere besides the face?
Yes, rarely it can involve the neck, chest, the upper arms or forearms and it’s called “Extra facial melasma”
How is it diagnosed?
Most of the time a dermatologist can diagnose melasma by just examining it.
A wood’s lamp examination may be used to assess the dept of the pigmentation i.e if it is epidermal (superficial) or dermal (deep) pigmentation. Epidermal pigmentation respond to treatment better.
Occasionally a skin biopsy (examining of a skin sample under a microscope) may be required for a definitive diagnosis as all facial pigmentation is not melasma.
Treatment options
The hunt for the cure for melasma is still ongoing.
Though numerous treatment options are available now, there is still no “one product” that does it all.
The mainstay of treatment is avoiding the factors responsible for it as much as possible. Since one cannot change one’s genetic makeup, taking measures to avoid the modifiable factors (such strict sun protection) will help prevent its occurrence and reduce the appearance of an already developing melasma.
Its always good to know your personal risk of developing melasma so as you can actively prevent it from occurring in the future.
If melasma is highly prevalent in your ethnic group (for eg: melasma is highly prevalent in my hometown i.e Shillong, Northeast India) start taking preventive measures at the earliest. Its best to consult a dermatologist as early as possible at the start of the pigmentation rather than after a trail and error of using multiple self prescribed creams and remedies.
Shillong, though blessed with its hills, rivers, waterfalls and clouds, being at a higher altitude (1525 m above sea level) means it gets more UV rays than lower altitude areas and the cloud cover aids in scattering these UV rays. Understanding these facts will help individuals be more aware of the need of sun protection even in cloudy, pleasant days without the sun shining bright.
The first step to the treatment or prevention of melasma is strict sun protection. No creams, chemical peels or LASERS will effectively work if one is not complaint with this step
Gel formulation or matte finish for those with oily skin
Apply to both face and neck at least 20 mins prior to sun exposure and reapply every 2 hours especially when outdoors
Sunscreen application should be on all days even when the sky is cloudy or rainy
Use a sunscreen even when indoors (as glass cannot filter UVA light)
Other measures of sun protection include using a wide brim hat during your outing tot he beach or during any outdoor activity.
Avoid the peak hours of the day such as between 12 noon -2 pm when the sun is directly above the earth.
Seek shade whenever possible
Treatment to reduce pigmentation
Now that we’ve had sun protection covered, you will need to seek expert opinion (dermatologist) for further management as there are many active ingredients available for treating pigmentation and not everything is suitable for everyone.
If you are on medications such as oral contraceptive pills containing estrogen or drugs for seizures such as phenytoin which could be the potential cause of the melasma, then its best to speak to your treating physician for a possible changeover of the medications.
What are the treatment options available?
To understand how the treatments work, we first need to have an overview of how melanin (pigment responsible for our skin, hair, eyes colour) is formed.
Melanogenesis i.e process of melanin formation in melanocytes (cells for melanin production). The 3 main types of melanin are eumelanin brown, eumelanin black & phaeomelanin (yellow red). Humans have all 3 types but the ratio of each type of melanin is different in different ethnic group. For eg more pheomelanin is present in red heads with pale fair skin, more of brown eumelanin is seen in blondes and more of eumelanin black is seen in brown-black skin type with black hair.
Topical medications for melasma
Various options are availabe in the form or creams, ointments or serums and the choice will differ from patient to patient.
Topicals required long term and consistent use for the best results.
Not every option will work for everyone
Some of the active ingredients that are use to reduce pigmentation are enumerated in the tables below:
There are numerous options for the treatment of melasma, and the choice will depend with every patient.
For best results, sun protection, strict compliance and abundance of patience is required as improvement can only be appreciated after months of consistent skin care routine.
Oral medications for melasma
Trenexamic acid – An anti fibrinolytic drug that prevents the breakdown of protein (fibrin) present in blood clots. Therefore it is traditionally used to treat bleeding disorders.
It has been shown to be effective for the treatment of melasma in low doses. It has been show to produce results in 3 months but relapse rates are high and melasma recurs within 3 months of discontinuation of the drug.
Side effects are nausea, vomiting & serious side effects such as heart attacks, blood clots in veins of legs, renal injury (kidney problems) could potentially occur in individuals at risk.
Chemical peels
Dermatological procedure where acids of higher strength is used such as glycolic acid, salicylic acid, trichloroacetic acid etc are applied to the face or pigmented area by a dermatologist for a short contact time.
The procedure is done every 3-4 weeks for 5-6 sessions depending on the patient’s response.
Second line treatment for those not responding to topicals alone.
Expensive and requires an experienced hand.
LASER for melasma
Various types of LASER are available for the treatment of melasma.
LASER treatment can be tricky especially in individual’s with darker skin type as the risk of pigmentation is higher. LASER are usually reserved for resistant cases not responding to the above mentioned treatment options.
LASER are not one time treatment. Creams and sunscreens will still be required to maintain the result and prevent recurrence.
LASER treatment are expensive but may be worth it when done by experienced hand.
There is still no cure for melasma.
Seek guidance from a dermatologist as the appearance of the pigmentation can be improved with either depigmenting creams & sunscreens or a combination of treatment especially when the treatment is started early.
Dr Naphisabet Wanniang 
