What’s New in Melasma Treatments?

In Dermatology by Andrei Metelitsa, MD

Melasma is a disorder that affects the pigmentation of the skin. The pigment cells reach into the dermal layer of the skin, yet treatments to the epidermis can seriously lighten the pigmentation changes.

Melasma may be triggered by trauma to the skin. This could be from mistakes in extracting blackheads or in waxing. Other causes of melasma includes lack of essential fats in the skin, lack of antioxidants, acne, scrapes, cuts, burns, curling iron burns, picking or pulling at the skin, tanning and chemical peels that are too harsh.

It is also triggered by pregnancy hormones in a lot of women or even from birth control pills. The enzyme called tyrosinase is affected in pregnancy; the stem cells that produce new skin cells have higher doses of pigment in them and melasma results. Medications such as antibiotics may also cause melasma.

Dermabrasion, chemical peels and laser therapy can be effective but can also be associated with prolonged recovery and risk of complications. Unfortunately in some, there can be greater pigmentation problems and scarring. But in others, these treatments work really well.

Laser Melasma Treatments Work – Check Them Out

First let’s talk about the melasma treatment of laser, which resurfaces the surface of the skin. Here’s some background information on the laser procedure.

If you have melasma, you may feel exactly like this woman who mustered up the strength to go on the television show, The Doctors and talk about it. She tried Accutane and chemical peels and got no results at all. She was afraid to go anywhere without makeup and didn’t want to have to hide from everyone anymore. She decided to try the laser treatment called fractional CO2 or fraxel. (Fraxel does have a lot of down time.) Check out her story here: https://youtu.be/9Nt98gEEmI4

Interestingly, there’s no follow-up to her case. Does that mean that the laser treatment didn’t work also? We don’t know… but laser does work for a lot of people when other treatments don’t work.

Here’s another story of a woman over the age of 40 who had tried chemical peeling in the past but still suffered from melasma. Her dermatologist recommended a laser treatment called the Dual Yellow laser treatment, one that is used by doctors for melasma treatments. Here’s her video: https://youtu.be/qPijdp8kK0g

The Spectra laser is also used for melasma treatments. For this type of treatment, one treatment is used each week for about ten weeks. This woman is so happy with the results and especially loves people stopping her on the street saying she has perfect skin. Here’s the link: https://youtu.be/-FtyjwxWqrc

What Do the Studies Say on New Melasma Treatments?

There are many new melasma treatments you can choose from. Below is a summary of some of the most recent news on melasma treatments:

1. Microneedling for Melasma
Microneedling is a new treatment that may be safer in women who have darker skin than fractional CO2 and chemical peels. It’s also called collagen induction therapy and Kim Kardashian had the procedure done. The method pierces the skin in many little areas, which causes your body to start a massive repair process. Since the needles penetrate the skin, they do draw blood and the method is also called the Vampire Facial. Of course, the blood is wiped off the face after the procedures.

The results are seen in the next day, but two days later your skin glows. You start creating new collagen. Treatments are done every 4 to 6 weeks. You’ll have 4-6 hours where you look like you have a sunburn but then after that, the skin starts to heal. Here’s a link to watch the procedure done professionally: https://youtu.be/KToXoElqjSo

There are products on the market called DermaRollers that can also mimic the microneedling done at a dermatologist’s office. However, these products won’t penetrate the skin deep enough in cases where you have the melanocytes that produce the pigments. It’s possible that over time, they may help a lot, though.

In the research studies, microneedling has already shown to be effective for melisma, skin rejuvenation, acne and excessive sweating.

2. Liposomal Tranexamic Acid – Not Used in This Country Yet
In Poland, a new treatment called liposomal tranexamic acid was compared in a split-face trial of 23 women for 12 weeks. On one side of the face, the women applied 5% topical liposomal tranexamic acid and on the other side, 4% hydroquinone cream twice daily. Hydroquinone is the gold standard of care for melasma in the dermatology world.

They also used sunscreen in the morning. The results were better with the liposomal tranexamic acid cream and there were no side effects with this new melisma treatment. The women noted irritation from the hydroquinone.

3. Plant Skin Lightener Called Arbutin
Arbutin is one of the most effective lightening substances, according to one researcher. One plant called Serratula quinquefolia is a source of arbutin and contains 6.86% of the medicinal constituent. One advantage of this plant is that it does not contain hydroquinone, which can have side effects and irritate the skin.

Scientists in Poland reported in the Journal of Cosmetic Dermatology that a water extract-containing cream (2.5% arbutin) applied twice daily on the areas of melisma and old age spots was effective in women. Seventy-six percent of the women with melisma had documented lightening of the skin and 56% of those with sun spots did, too. The product isn’t on the market right now but expect it to come out within about five years.

Natural Melasma Treatments That Have Been Used for Centuries

If you have melasma, you can always try some natural treatments. For some people, they work but other people will need the services of a dermatologist to eliminate the melasma. Here’s a list of some of these natural treatments:

1. Lemon juice
2. Papaya – an exfoliant
3. Gotu kola – removes dark pigments when applied directly to the skin. Works best when ginseng is added to the gotu kola
4. Vinegar
5. Turmeric
6. Onion juice – the sulfur in the onion fades dark patches yet nourishes skin cells
7. Horseradish – bleaches it
8. Aloe vera
9. Oatmeal and milk
10. Almond and honey face mask
11. Turmeric

Decide what you’re going to do about your melasma. Create a plan of action and then take action. If you want to try a dermatologist procedure, then give us a call at 403-271-3627.

Cohen, B.E. and Ebuluk, N. Microneedling in skin of color: A review of uses and efficacy. J Am Acad Dermatol 2015 Nov 5.

Lee, A.Y. Recent progress in melisma pathogenesis. Pigment Cell Melanoma Res 2015 Nov; 28(6): 648-60.

Banihashemi, M., et al. Comparison of therapeutic effects of liposomal tranexamic acid and conventional hydroquinone on melisma. J Cosmet Dermatol 2015 Sep; 14(3): 174-7.

Morag, M., et al. A double-blind, placebo-controlled randomized trial of Serratulae quinquefoliae folium, a new source of beta-arbutin, in selected skin hyperpigmentations. J Cos Dermatol 2015 Sep; 14(3): 185-90.