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How do you combat melasma?

The ESK blog

How do you combat melasma?

29 January 2022

What is melasma?

Melasma is a common, pigmentation issue where there is symmetrical (same both sides) but irregular shaped brown patches on the face especially the forehead and cheeks.

Why does it happen?

This is complex. There are multiple steps involved.

Your pigment producing skin cells are called melanocytes and they make your skin’s pigment known as melanin. Critical to this process is the enzyme tyrosinase located in the melanocytes. Tyrosinase is stimulated by exposure to the sun’s UV rays.

This pigment is then transferred to the adjoining skin cells via long tentacles that reach throughout the skin, ideally delivering protective melanin evenly throughout the skin.

But pigmentation involves more than just an overproduction of pigment. If you take a biopsy of melasma skin, apart from higher levels of melanin you’ll notice some other specific features in the skin;

1. Solar Elastosis. This form of solar skin damage is the accumulation of abnormal elastic tissue in the deeper levels of the skin (dermis) resulting from chronic sun exposure. Melasma patients have been found to have high levels of solar elastosis.

2. Accumulation of mast cells. Numbers of the inflammatory cells called mast cells are higher in melasma skin than in unaffected skin. Mast cells induce lots of blood vessels into the area, which is another prominent finding in melasma. These blood vessels are thought to contribute to melasma.

3. Inflammation of the skin. Melasma skin tends to be more inflamed skin. We know inflammation makes pigmentation worse after acne as well.

Things that can increase melasma;

• Sun. The sun’s UV rays stimulate tyrosinase plus they cause inflammation in the skin. When it comes to pigmentation, they are enemy number one. UV rays also cause Oxidative stress to the skin which is also believed to result in pigmentation.

• Hormones. Melasma is MUCH more common in women than men and often happens in pregnancy and to women taking the oral contraceptive pill. Oestrogen can bind to melanocytes and turbo charge melanin production. Then again, postmenopausal women taking HRT containing progesterone can develop melasma, while those on oestrogen alone do not. So progesterone might be the culprit!

Combatting melasma

Melasma is no different to other forms of pigmentation when it comes to treatment. We have a comprehensive run down in our free Pigmentation eBook. A pinch of prevention is worth a pound of cure. Wearing a broad-spectrum sunscreen from sun up to sun down as well as avoiding the sun in the middle of the day and wearing a hat are all critical steps for people wanting to get rid of their pigmentation. Otherwise, all the treatment in the world will only work so much before all the pigmentation comes back with a bang.

When it comes to treatment, sadly, no single treatment for pigmentation is generally effective. Treatments should be combined to hit pigmentation from all angles and achieve the best results. And combatting pigmentation is a marathon, not a sprint. You need to be patient.

Another thing to be aware of is that pigmentation has a habit of coming back when you stop treatment. So, ideally you want treatments that are safe to use long term.

Tyrosinase inhibitors

Hydroquinone is the gold standard of tyrosinase inhibitors because it’s so effective at combatting pigmentation. On the downside, it has been found to be potentially cancer causing to cells. Kidney tumours, leukaemia and damage to DNA were found in animal experiments with scientists worried about carcinogenic properties of hydroquinone after prolonged use.

It has also been linked to a number of side effects including irritation, redness, burning, and ochronosis (slate grey pigmentation that can develop after prolonged use and is super hard to get rid of.)

4-n-butylresorcinol

From studies, we know that 4NB is the most potent inhibitor of human tyrosinase around. Studies show depigmentation happens with 0.1% twice daily and 0.3% once daily application. How effective? 84% of people get significant reduction in their pigmentation. It is very well tolerated and can be used long term.

Shop 4-n-butylresorcinol:

Enlighten

Enlighten

A gentle yet effective tyrosinase inhibitor to fade pigmentation and age spots.

  • Lighten & brighten skin appearance
  • Even out skin tone 
  • Increase skin elasticity 

Arbutin

There have been a couple of small very poor-quality studies of arbutin showing that it has a very weak tyrosinase inhibitory effect.

Kojic Acid

Kojic acid is more powerful at inhibiting tyrosinase than Arbutin, but it’s way less effective than 4NB.

Other cosmeceuticals

Vitamin A

Vitamin A combats oxidative stress, reduces melanosome transfer from melanocyte to the rest of the skin cells. It also increases skin cell turnover effectively flushing excess pigment out of the skin. It isn’t used alone but is an important additive to a tyrosinase inhibitor for best results. Remember that Retinal (Retinaldehyde) is the most effective and best tolerated of vitamin A for your skin, being 20 times more powerful than Retinol.

Ultimate A

Ultimate A

Vitamins A and B. High strength. Effortlessly improves skin texture and tone for skin that is soft smooth and supple. Also effective in managing acne. 

  • Rebuild collagen
  • Increase skin elasticity
  • Reduce hyperpigmentation

Vitamin B3 (Niacinamide)

Niacinamide is not only an antioxidant but it also inhibits pigment transfer inside the skin. Studies show fairly impressive results in combatting pigmentation with hardly any side effects. A great add on!

Vitamin C

L-Ascorbic acid, the evidence-based form of Vitamin C has tyrosinase inhibiting properties but is also an antioxidant and anti-inflammatory ingredient. Like niacinamide, it is less effective on its own than a tyrosinase inhibitor, but I would definitely add it into the cosmeceutical mix.

Ferulic Acid

Studies show Ferulic Acid penetrates deep into the skin and can not only directly inhibit tyrosinase but also stop melanocytes proliferating. It is often combined with Vitamin C for best results.

Shop Vitamin C & Ferulic Acid:

C Forte

C Forte

Hydrate and brighten your skin with this 16% L-Ascorbic Acid Serum. Vitamin C's sun damage reversing abilities are boosted when Vitamin E is added. Adding Ferulic Acid boosts it to still further for your best glow.

  • Hydrate dry skin.
  • Repair sun damaged skin.
  • Reduce fine lines, crows feet and pigmentation.

Alpha Hydroxy Acids (AHAs)

There aren’t a lot of studies specifically for leave on AHA serums for pigmentation but there is some evidence that AHAs help with skin cell turnover which should result in quicker pigment dispersion. Plus, AHAs enhance the effectiveness of Retinal.

Shop AHAs:

Smooth Serum

Smooth Serum

An Alpha Hydroxy Acid exfoliating serum for daily night use.

  • Smoother skin
  • Evens out skin texture
  • Promotes skin cell turnover


Procedures

Lasers, peels and light treatments have all been used to fight pigmentation. Their results can be great but can cause quite nasty side effects and even worsening post-inflammatory pigmentation. We tend to keep that in our back pocket for when cosmeceuticals don’t work.

If it’s related to pregnancy, patience is a virtue! Some of my patients have had to stop the oral contraceptive pill to get rid of their pigmentation!

Shop Kit:

Pigmentation Kit

Pigmentation Kit

This ultimate anti-aging and pigmentation kit delivers deep hydration, targets hyperpigmentation and age spots.

  • Fade pigmentation and age spots
  • Brighten dull skin 
  • Repair visible signs of aging

We've swapped the C Serum Lite with the new C Forte. If you prefer the C Serum Lite, you can build your own kit here.