Erasing pigmentation

BY TEE SHIAO EEK

ON a scale of one to 10, with 10 being the most nasty, awful disease you could have, melasma probably sits way below one. Yet, the stigma and psychological effects of this common pigment disorder cannot be underestimated. 

Dr Saadiah Sulaiman … ‘Melasma is a disorder that needs special care and treatment.’

“Melasma (usually) appears as blotchy brownish or black spots on the forehead, cheeks, nasal bridge or upper lip,” said Dr Saadiah Sulaiman, consultant dermatologist, at the recent launch of a new oral treatment for melasma. 

This insidious condition is one of the most common skin disorders suffered by Asians, affecting approximately 40% of women and 10% of men in the general population. It affects dark-skinned individuals more commonly than those with fair skin.  

The precise cause of melasma is unknown, but UVB radiation from sunlight is a major factor that contributes towards melasma development.  

When areas of the skin are exposed to sun, melanocytes in the skin increase production and deposition of melanin (pigment) in the skin cells. This leads to discolouration of the skin. 

“It is thought that UV light causes peroxidation of lipids, which generates free radicals and leads to pigmentation,” explained Dr Saadiah. 

It is common for pregnant women to develop melasma, hence the phrase “mask of pregnancy”. Other causes include oral contraceptives, genetic factors, as well as certain cosmetics, phototoxic drugs or epilepsy drugs.  

“Melasma is a disorder that needs special care and treatment. (However), it is difficult to treat because not everybody responds to the same type of treatment,” said Dr Saadiah. 

Moreover, many Malaysians make the mistake of self-treating the condition, or visiting pharmacies and beauty salons, instead of dermatologists.  

“The objectives of treatment include reduction in size and intensity of melasma, as well as prevention of recurrence. Many women use external methods to reduce skin pigmentation, but there are possible side-effects, including redness, stinging sensation, irritation, bacterial infection, scarring and even post-inflammatory hyperpigmentation.” 

Treatment for melasma ranges from topical creams to chemical peels and microdermabrasion, all with varying results and potential side effects. For instance, hydroquinone (HQ), an ingredient used in some creams, can cause “permanent pigmentation with increasing concentrations,” said Dr Saadiah. 

Some of the more effective medications include retinoic acid, which causes histological and clinical improvements under the skin, and azelaic acid, which is fairly effective, with transient side effects like itchiness and burning. 

Then there is laser-resurfacing, which produces good results, but has to be done by an experienced dermatologist. Furthermore, the response is transient and there is a risk of post-inflammatory hyperpigmentation, cautioned Dr Saadiah. 

Currently, research is being done on the role of anti-oxidants to combat the free radicals produced in the skin.  

“One type of anti-oxidant is French maritime Pine Bark extract, which stabilises collagen, acts as a free radical scavenger, inhibits UV radiation and is more powerful than ordinary anti-oxidants, like vitamins C and E,” she said. 

This anti-oxidant is one of the ingredients found in the new oral treatment for melasma. This medication, which contains natural extracts from plants and seaweed, is a powerful antioxidant that is over 50 times more potent than vitamins C and E, said Trissia Chandra, Technical Service Manager of Mega We Care Malaysia, the nutraceutical company that produces this oral treatment. 

“It also blocks excessive melanin production by suppressing excessive formation of melanocytes and at the same time controlling the activity of melanocytes to block over-production of melanin,” she elaborated. 

The medication, which comes in the form of capsules to be taken daily, also repairs skin damage by soothing inflammation and strengthening capillaries in the skin. 

Dr Saadiah emphasised that avoidance of sunlight and the use of sunblock are major factors in treating melasma, regardless of what medications are used. 

“The choice of sunblock is important. It must be able to block UVA, UVB and visible radiation. Use physical sun block that contains zinc oxide and titanuim dioxide,” she urged. 

Even after treatment, melasma can recur, particularly after being exposed to the sun again.  

“The product can be taken regularly to prevent recurrence of melasma.  

It is (also) advisable to use some form of sun protection, particularly broad-spectrum sunscreen,” said Chandra.