Melasma Treatment

Melasma is a difficult skin condition to treat. As the hyper pigmentation characteristic of the disease develops over a period of time, it takes time to resolve as well. Sometimes the Melasma may resolve spontaneously without resorting to any treatment. At times, it is sufficient to avoid sun and use sunscreens abundantly to settle the condition. Your Melasma may even disappear up on the cessation of the birth control pills or the hormone therapy that you may be undertaking. However, if it does not clear after these simple steps, then it may be difficult to treat. The best treatment available for these resistant cases includes the following steps:

Bleaching Creams

The bleaching creams work by preventing the formation of melanin by the Melanocytes. The different bleaching creams that inhibit pigment formation include:

• Hydroquinone
  Studies prove that hydroquinone cream when used in a concentration of 2 to 4% is highly effective in lightening the skin patches of Melasma. It is to be applied to the hyper pigmented areas twice a day followed by a sunscreen. It inhibits a chemical, known a "tyrosinase", which is essential for the production of melanin. It also converts into certain chemicals which can damage the Melanocytes. Hydroquinone is available in both cream and alcohol based solution forms. Concentrations of 2% are easily available as an over the counter product but concentrations of 4% and above are available on your doctor’s prescription only. Higher concentrations are more effective but they also have more side effects. They can lead to burning of skin, photo toxicity, and even a permanent skin discoloration called as "ochronosis." But despite these side effects, hydroquinone remains the most effective bleaching cream for the treatment of Melasma.
• Azelaic acid
  Azelaic acid, available in a concentration of 20% is believed to be as effective as 4% hydroquinone and is better than its 2% variant for treating Melasma. It targets only those Melanocytes which are hyper active and produce excess amount of melanin and does not harms the normally functioning Melanocytes. The only known side effect of Azelaic acid is some skin irritation.
• Kojic acid

Peeling off Agents

They work by remove the superficial layer of the skin in which the hyper pigmentation is present. They include:

• Retinoic acid
  Better known as "tretinoin", retinoic acid is less effective than hydroquinone and takes more than 6 months for the results to show. It is used in a concentration of 0.025 to 0.1%. It may result in dermatitis and is not supposed to be used in case you are pregnant.
• Topical alpha hydroxy acids
  These may include glycolic acid and lactic acid. They are available in the form of creams or as superficial chemical peels meant for repeated use.
• Dermabrasion and microdermabrasion
  These procedures often require multiple settings and more often than not, the results are unpredictable. Moreover, they have to be done under expert hands as accidental damage to Melanocytes can lead to excessive melanin production and enhance the hyper pigmentation of Melasma further.

Laser Therapy

Also known as "laser resurfacing", it has been used to treat Melasma with varying degrees of success. It is certainly not the preferred line of treatment for this condition. In fact, in certain individuals, the clinical features of Melasma may actually worsen temporarily after laser therapy. Newer techniques, like the use of "fractional lasers" are a better option as they are safer.

Intense Pulsed Light

This procedure uses a pigment laser to destroy the excess pigment deposited in the skin layers. It gives quick results but requires multiple settings for an effective treatment of Melasma.

Despite these recently introduced methods of treatment, topical depigmenting agents like hydroquinone remain the best choice for the treatment of Melasma. Hydroquinone may be combined with tretinoin and a topical corticosteroid for a safe and effective treatment. The only FDA approved cream for the treatment of Melasma contains hydroquinone 4%, Tretinoin 0.05% and flucinolone acetonide 0.01%. These combination creams when used along with sun blocks which have an SPF of at least 30 provide a fast and effective relief from the hyper pigmentation of Melasma.