How to treat melasma, by dermatologist

Consultant dermatologist, Dr. Ayesha Akinkugbe, has said while melisma may remain incurable, there are several treatment options available to help patients regain the strength of their skins.

Akinkugbe told The Guardian that the chronic skin condition remains one of the terrible skin problems that often bring patients to the hospital environment.

Melasma, according to the consultant at the Department of Medicine, College of Medicine, University of Lagos (CMUL), said melasma is an acquired skin condition that presents as darkening in sun-exposed areas of the skin.

It occurs as a result of increasing melanogenesis, which is the process where melanin is formed in the skin. Melanin is that substance responsible for pigmentation in the skin.

Melasma usually presents as symmetrically distributed hyper-pigmented patches, which can be confluent or punctuate. Areas most commonly affected are those that are mostly exposed to sun such as the cheek, upper lip, forehead and chin.

According to her, “the cause of melasma is uncertain. However, there is a direct relationship with female hormonal activity as it is commoner in females than males, develops or worsens with pregnancy and use of oral contraceptives. Estrogen receptors appear to be unregulated in melasma.

“Other factors implicated are photosensitising substances such as drugs like tetracycline, ovarian and thyroid dysfunction. The most important factor in development of melasma in a susceptible individual is sun exposure, which induces the production of alpha melanocyte stimulating hormone, corticotropin,” she said.

Melasma is rare before puberty. It is commoner among the female folks, with 90 per cent of those affected being women. It most commonly occurs during their reproductive years. Melasma also occurs in 15 to 50 per cent of pregnant women. Melasma can develop for the first time in pregnancy or can be worsened by pregnancy due to un-regulation of estrogen receptors.

Akinkugbe added that while nutritional deficiencies could cause other skin conditions, it does not cause melasma on its own.
She said further that melasma could be difficult to treat. “The pigmentation develops gradually and resolution is also gradual. Strict avoidance of sunlight and use of photo-protection with sunscreen with a sun protective factor of 30 to 50 can be helpful.

“A dermatologist best carries out treatment, and it includes the use of depigmenting agents. Prevention is the best form of management with use of Sun Protection Factor (SPF) 30 sunscreen and above.
“If an individual being treated for melasma does not avoid sun exposure, the treatment is likely to be unsuccessful,” she said.