AS THE SUNNY DAYS BECOME MORE, the issue of protecting the skin from ultraviolet radiation becomes more acute. In addition to malignant skin tumors and photoaging, it can lead to brown or blue-gray patches on the face called melasma. Most often it occurs in women in their twenties and fifties, and the likelihood of melasma is increased by genetic predisposition and hormonal changes. Let’s figure out what this state is.
What is Melasma
Melasma is a condition in which dark, well-defined patches appear on the skin. Physical well-being is not disturbed, but due to a change in the appearance of the skin , the emotional perception of oneself can suffer – and with it the quality of life. Melasma spots can be brown or slate gray. Most often they appear in the central zone of the face (on the back of the nose, forehead, cheekbones and upper lip) and along the line of the lower jaw, but they can also occur in other places, especially exposed to solar radiation: forearms, shoulders, décolleté.
With melasma, an increased deposition of melanin pigment occurs, and this can occur in different layers of the skin and at different depths – the visible color of the spots depends on this. In superficial deposition, when melanin is located between epidermal cells or within keratinocytes, the spots appear brown, and deeper (dermal) deposition results in gray-blue, slate-gray, gray-brown spots. In this form, melanin is in the cells of melanophages – they absorb it in more superficial layers, and then migrate deeper. Most often, the pigment is deposited simultaneously in different layers and the melasma is of a mixed nature.
Hormones and the sun
The main cause of staining is UV radiation: most people with melasma experience daily or intermittent sun exposure. Typically, pigmentation increases during months of intense sun exposure, and may decrease or even disappear in winter. People with darker skin tones are more likely to suffer from melasma.
Another important factor is hormones , in particular, increased levels of estrogen, progesterone and melanocyte-stimulating hormone. Due to endocrine changes, age spots often appear during pregnancy – another term is also used to denote them, chloasma. Increased pigmentation is so common during this period that before it was even called the “mask of pregnancy”. Hormonal contraception or hormone replacement therapy during menopause can also contribute to the appearance of age spots.
Melasma is much less common in men – according to the American Academy of Dermatology, they account for 10% of cases; at the same time, the relationship with the hormonal background in men is not yet very clear. Irritating cosmetics (for example, gommages or peels) can contribute to the appearance of age spots, possibly a hereditary predisposition is also important. So, if a person wants to avoid the appearance of spots, it is necessary to carry out prevention – to protect the skin from ultraviolet radiation and remember the risk of pigmentation when taking oral contraceptives and hormone replacement therapy.
UV protection of the skin remains the main prevention measure for skin cancer and melanoma, and it also helps prevent melasma and reduce (or even eliminate) pigmentation that has already appeared. Of course, melasma is not a disease and does not need to be treated; especially since it is a chronic and recurrent condition , and perhaps the result will not be worth the effort. But if the stains are upsetting, there is something you can do.
The most important thing for shrinking existing lesions and preventing new ones is protection from ultraviolet rays, including wide-brimmed hats and sunscreens. It is important to avoid direct sunlight, sunbathing, and tanning beds. The cream should provide protection against the rays of spectrum A (depending on the country, the marking is “broad spectrum” or marking with asterisks indicating the degree of protection against ultraviolet A spectrum) and spectrum B (marked with an SPF value, for patients with melasma it is recommended to use SPF 30 or higher ). The sunscreen should be applied before going outside and then renewed every two hours. The cream should be enough – for the face, ears and neck it is 5 ml (one teaspoon) of the product. The use of photo protection during pregnancy can effectively prevent the onset of pigmentation.
Melasma can go away on its own – most often when pigmentation is associated with pregnancy or hormone intake. Melasma from pregnancy usually regresses within a year after delivery, but some lesions may never completely disappear.
Sometimes photo protection is enough to make the lesions disappear – but this is not always the case. To lighten pigmentation spots, creams containing 2% hydroquinone are most often used. This substance reduces brown staining by acting on the enzyme tyrosinase, which is necessary for the synthesis of melanin in cells. Products with hydroquinone are usually applied to areas of pigmentation twice a day – in this case, a photoprotective cream should be applied on top (sometimes a photoprotection factor is included in a product with hydroquinone). Hydroquinone works for all types of melasma, but works best for superficial (epidermal) melanin deposition.
One method that is effective for all patients with melasma has not yet been found, so doctors usually combine methods and drugs, especially for recurrent pigmentation. In addition to hydroquinone, azelaic acid is used at a concentration of 15–20%, retinoic acid ( tretinoin ) at a concentration of 0.025–0.1%, koic, lactic, glycolic acids; Your doctor may prescribe a drug with a small dose of corticosteroids . If all this is not enough, you can try cosmetic procedures: lasers and chemical peels .
It is worth remembering the risks of “curing” melasma and assessing them wisely – perhaps taking age spots will be a more careful decision regarding your health than trying to get rid of them. It is important to remember that with prolonged use of hydroquinone, especially at a high concentration (4% and higher), the so-called exogenous ochronosis , specific persistent changes in skin color , can develop . This is a common occurrence in regions where people with ethnically dark skin color use high concentrations of the substance – 10% and even 20% in an attempt to lighten it. In addition, active ingredients for pigmentation correction often irritate the skin.
In the meantime, research on new drugs is underway: for example, the effectiveness of tranexamic acid was noted when injected into the pigmentation focus or when applied externally , there is positive data on the external use of rucinol. However, the mechanisms of the effect of these substances on pigmentation are not yet very clear, and the drugs themselves are not registered for the treatment of skin hyperpigmentation.