The Melasma
Melasma is a particular form of hyperpigmentation that differs from sun spots or post-acne spots in that it is particularly difficult to treat. Today I'm going to decipher for you the latest scientific articles and we're going to look at how to treat melasma and hyperpigmentation effectively, talking about science, skincare routines and lifestyle, as well as peels, microneedling and lasers.
Understanding Melasma:
The appearance of melasma is due to a disorder of the melanocytes, which begin to produce melanin in large quantities in certain specific areas, such as the forehead, cheekbones and upper lip. It also has the particularity of mainly affecting women.
Triggering factors include sun exposure, pregnancy or hormonal imbalance, inflammation of the skin by our diet or the use of the wrong cosmetics, but there is also a genetic predisposition to melasma.
As I've already told you, melasma treatment is complex, which is why today we're going to bring a little science to an industry that prefers to use superlatives rather than bring knowledge to people wishing to improve their skin.
We're starting with a scientific study published in 2019. Don't be afraid of this diagram, it may seem complicated, but it will help us understand which treatments are really effective.
What we need to remember from this diagram is that, contrary to what we initially thought, melasma is not just a problem of melanocyte dysregulation, but also involves keratinocytes, mast cells, skin inflammation and effusion of the basal membrane, and this is important! Because it's going to help us put an end to melasma.
Fighting Melasma:
If you want to combat melasma, you have to take these 5 mechanisms into account in order to maximize the benefits of your treatment. anti-spot care. The tyrosinase pathway, keratinocyte irritation, skin inflammation, mast cell increase and basement membrane degradation.
The basal membrane:
The first is that you mustn't break down the basal membrane, and so you shouldn't use a laser treatment or peel that's too powerful to solve the problem quickly, because you'll actually make things worse. These treatments, which are too powerful, will break down the basal membrane and cause skin inflammation, which can make melasma worse.
Tyrosinase:
The second mechanism is to reduce the action of tyrosinase. Tyrosinase is the enzyme that transforms tyrosine into melanin, which is how increased estrogen aggravates melasma.
Skin inflammation and keratinocyte irritation
Secondly, chronic inflammation of the skin by the sun, diet and cosmetics containing irritants will aggravate melasma. Here, too, I'll explain how to take effective action.
Sun exposure
And the final mechanism is that sun exposure will increase the number of mast cells, which are a major cause of hyperpigmentation in melasma, and to combat this there is an effective active ingredient, tranexamic acid.
As we've just seen, there's no simple treatment capable of knocking out melasma, so it's a real change of lifestyle that's needed to treat melasma, and we're going to start with the most effective one - sun protection - because we can see that UV rays, as well as visible light, are at the source of all the mechanisms leading to melasma.
Sun protection
So, yes, you need sun protection, but not just any kind. You need to opt for mineral sunscreens with zinc oxide, which will protect you from the UVB and UVA rays that damage your skin. I also recommend tinted sunscreens, which often contain iron oxides to protect you from the blue light emitted by your smartphones and computers. If you don't want to use a tinted sun cream, you'll need to use a BB cream containing iron oxides, as more and more studies are showing a link between visible light and melasma. Another subtle point to be aware of is that sunscreens contain filters that are more or less irritating, notably avobenzone or octocrylene, and we've seen that skin irritation is to be avoided if you have melasma, so take a good look at the ingredients before you buy, and above all pay close attention to how your skin reacts to the introduction of each new product. The other thing to consider is that your melanocytes have become super melanocytes, and even a very short exposure to the sun will be enough to reactivate them. This means that you need to put on sun protection every day, which also protects against visible light as we've seen, and don't forget to renew it every two hours if you're outside.
Ingredients effective against melasma:
The active ingredients that regulate Tyrosinase are Hydroquinone, azelaic acid, glycolic acid and retinoids. In each case, I'll give you the level of evidence, bearing in mind that: 1 is the highest level of evidence of efficacy, and 5 is the lowest. For example, if an expert asserts that a molecule is effective without a study having been carried out, the level of evidence is 5, i.e. the worst.
For hydroquinone, your dermatologist can prescribe a preparation made in a pharmacy with several depigmenting medications. However, it should not be used over a long period of time, as there is a high risk of side effects.
Azelaic acid This acid comes from seeds such as barley, wheat and rye, but is generally synthetic in cosmetics. Azelaic acid is also highly effective in treating acne and redness. If you'd like to find out more about this active ingredient, let me know in the comments section.
Glycolic acid also helps reduce the action of tyronisase, and it may be useful to add it to your melasma care routine.
Now let's talk about Tranexamic acid which regulates the action of tyrosinase, but also of mast cells, which induce neovascularization. We don't necessarily realize it, but melasma is characterized by hyper-vascularization, i.e. dilation of the small blood vessels in the skin, which is often difficult to detect because the skin is already hyper-pigmented. Look at the effects of tranexamic acid after 8 weeks' use on epidermal pigmentation, mast cell presence and neovascularisarion. Another study published in 2019 showed that topical use of tranexamic acid was as effective as hydroquinone without the side effects.
Niacinamide also plays a role, as it reduces the transfer of melanin to keratinocytes.
Vitamin C is also recommended, as it helps reduce the inflammation created by free radicals, diminishes the harmful effects of the sun and regulates the action of melanocytes. A study has also shown that taking vitamin C orally can be beneficial.
Retinoids are also extremely effective in shortening the cell regeneration cycle and regulating tyrosinase. Now that you know which active ingredients are effective, you need to know how to use them. The mistake not to make is to buy them all and start an ultra-complex skincare routine, as your skin won't be able to handle it. I recommend that you start step by step, as you don't want to create skin inflammation in people with melasma.
Cosmetic product recommendations
My recommendations for effective cosmetics for melasma and pigmentation spots:
C15 Super Booster
A serum containing 15% of pure vitamin C, ferulic acid and vitamin E, all with the right PH for optimal vitamin C penetration. A serum that can be applied in the morning
Skin type
All
Price
56€
More
Vitamin C is a benchmark active ingredient in the fight against hyperpigmentation
Minus
Always apply sunscreen afterwards.
Azelaic Acid Suspension 10%
A cream gel with azelaic acid. The high concentration of azelaic acid is effective against melasma pigmentation spots.
Skin type
All
Price
10,40€
More
An effective product at an affordable price
Minus
The texture is quite siliconized
Clinical Anti-Spot Serum
A serum containing tranexamic acid, niacinamide and bakuchiol. A good blend of active ingredients known for their action against spots. I recommend using this serum every day to effectively combat dark spots on the face.
Skin type
All
Price
52€
More
An excellent serum that I can recommend for reducing melasma.
Minus
No
-Tranexamic acid and Niacinamide: Stain serum from paula's choice
-Retinol: Granactive retinol from the ordinary
-USPF 50 sun cream:
An important point is to use an effective sun cream with zinc oxides. Iron oxides protect against visible light, and this is important in the fight against melasma. They must be present in your sun cream or in your BB cream if you use one.
After these 48 hours, you'll need to introduce retinol in the evening, after niacinamide, and start gradually, 1 day out of 2 or even 1 day out of 3, then slowly increase the frequency. You'll need to use a moisturizing cream either before or after applying the retinol.
Once retinol is well tolerated, you can introduce vitamin C in the morning just after cleansing, but before niacinamide and tranexamic acid. And if you want to go even further, you can insert azelaic acid in the morning after vitamin C, once vitamin C is perfectly tolerated. The last thing you need to know is to choose cosmetics that are fragrance-free and free from irritating substances.
Estrogen:
Now that you're up to speed on your skincare routine, that's all well and good, but it's not enough, and I still have a lot of advice to give you. Estrogen plays a major role in the appearance of melasma, so if melasma appears following the introduction of contraception, don't hesitate to consult your gynecologist to see if you can change your pill or contraceptive method.
Food:
On the other hand, as we've seen, anything that can cause skin inflammation is to be avoided, and a major source of inflammation is our diet. So if possible, avoid sugar and unhealthy industrial fats, and opt for a diet rich in antioxidants. Don't hesitate to subscribe to my newsletter to receive my advice on this type of diet.
Medical treatments for melasma:
Unlike other forms of hyperpigmentation, with melasma you need to use non-aggressive techniques, otherwise you'll end up with reactive hyperpigmentation. To give you an idea of what post-inflammatory hyperpigmentation is, it's skin that becomes darker after a small wound or acne outbreak.
From a medical standpoint, there are 3 main effective treatments: peels, microneedling and lasers. They should be considered as complementary treatments to the measures implemented previously, and not as a miracle solution to melasma.
As for peels and lasers, they should be avoided in summer, and several sessions should be carried out throughout the winter. The peel must be gentle enough not to aggress the skin and risk provoking reactive hyperpigmentation. Among the countless peelings available, one that has been widely studied in melasma is glycolic acid, which can also be combined with azelaic acid or kojic acid. Another technique is microneedling, which involves creating numerous mini-tunnels under the skin to facilitate the penetration of active ingredients into the skin. For lasers, we prefer non-abrasive lasers to avoid the famous pigmentary rebound, which absolutely must be performed by a doctor after skin preparation. Generally speaking, people with dark skin need to be extremely cautious and see an experienced dermatologist to avoid pigmentary rebound.
A team of Beverly Hills doctors, in an article published in 2016 proposes a treatment algorithm for people with Melasma that I present to you:
Phase 1 Sun protection and combination of topical active ingredients
If this fails, we move on to phase 2 and add superficial peels and non-abrasive lasers to the previous measures.
And if this fails again, we move on to phase 3, where we can add further treatments: radiofrequency, Q-switch laser, IPL and micro needling.
Remember, your melanocytes are out of whack, and a single day in the sun without protection can ruin a year's efforts.
I've given you the latest scientific data, and now that you have this knowledge, it's up to you to apply it.