Melasma (Jeragat) or Chloasma is a common pigmentary disorder that typically affecting Asians aged between 30-40s and postmenopausal women which is chronic in nature, manifesting as irregular-shaped brownish patches on the skin. It usually occurs in the areas exposed to sunlight, particularly the face with the upper lip, nose, cheeks, chin, and forehead the most common. Chronic ultraviolet (UV) exposure, genetic factors, medication, and sex hormones are believed to be the factor responsible for the development of melasma.

Melasma is a type of skin disease that consists of three different variants: epidermal (superficial), deep (dermal), and a mixture of both. Despite successful treatment, it often relapses due to repeated exposure to the contributing factors.

In the latest clinical data, the relation between melasma and the photoaging changes of the skin was discussed. It is found that melasma, a hyperpigmentation disease, is also a photoaging skin disorder.

The skin changes of melasma include solar elastosis, disruption basement membrane of the skin that leads to migration of pigment to the dermis, increased vascularization, and increase mast cells count that leads to inflammation. Solar elastosis is an accumulation of abnormal elastic tissues in the dermis due to chronic sun exposure.

A significantly higher degree of solar elastosis was observed in lesional melasma skin compared with normal skin.

Therefore the management of melasma is not just by focusing on the pigment cells and the pigmentary changes but also to improve the quality of the photoaging skin.

Although topical triple combination cream is still the treatment of choice as a depigmenting agent in treating melasma, anti-aging approaches have to be also considered.

Topical tranexamic acid, azelaic acid, ascorbic acid, niacinamide, resveratrol, and kojic acid can be used as alternative options for antiaging approaches.

Each of these ingredients helps in blocking and lighten up the pigment at various levels to prevent pigmentation.

As I mentioned earlier in my last writing, sunblock is very important in preventing pigmentation & further damaging that can lead to premature aging of the skin. In the case of a melasma patient, the usage & application of sunblock must be adequate and regular.

Other than that systemic tranexamic acid has been studied and has a promising benefit in reducing the melasma by reducing the formation of altered vessels. Energy-based devices like laser treatment and chemical peel also help in collagen remodeling and improving skin turnover. These physical treatments can be considered to improve the quality of the skin at the same time reducing the pigmentation from within.

DIAGRAM SHOWING THE HISTOPATHOLOGIC CHANGES OF SKIN WITH PIGMENTARY SKIN DISORDER-MELASMA

These pieces of evidence showed that therapeutic options must consider the photoprotection aspect of the skin, pigment cell activity, abnormal skin changes due to photoaging as a whole to have a better outcome of the treatment.

SUMMARY

Melasma is a type of skin disease that may cause a lot of distress and insecurity to the patient. However, it is not something that cannot be treated. Patients must focus not only on the pigmentation of the skin but the overall skin quality as well. Although treatment can be time-consuming and challenging,  patients must not give up to find the right treatment and information for themselves.

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