MELASMA
What is Melasma?
Melasma is a widespread skin condition that causes patches and discolored splotches to form on the face. Every year millions of people develop melasma, and a vast majority of those individuals are women, more specifically pregnant women. The discoloration typically forms on the forehead or in the T-zone and has been referred to as a “pregnancy mask.” Melasma can form due to several different factors; however, some of the most common reasons for development may include, but are not limited to:
- Hormones: While the exact reason hormonal changes can affect melasma formation is yet to be determined, medical professionals can draw a correlation between melasma, skin conditions, and hormone changes.
- UV Rays: Strenuous sun and radiation exposure to sensitive areas of the skin can result in hypomelanosis. When skin cells are damaged or diminished by sun exposure, they then produce too much melanin, which creates darker-pigmented splotches of skin.
- Genes: Family members with melasma may pass the genetic trait down, as it has been shown to be hereditary.
- Medical Factors: Various medical complications such as ovarian dysfunction and thyroid dysfunction can increase one’s chances of developing melasma; inducing allergens may also be found in medications, moisturizers, or cosmetic products.
Compounding for Melasma
Unlike many skin conditions, melasma does not create any irritation or discomfort; however, most individuals turn to treatment to remove the discoloration simply due to personal preferences. There are various different treatment options for patients dealing with melasma; some of the most commonly seen practices include:
Limiting Sun Exposure: Anyone who suffers from melasma should limit and avoid sun exposure altogether to increase the chances of successful treatment and decrease the chances of recurrence. However, if sun exposure cannot be avoided, it is beneficial to have a strong, high-SPF sunscreen handy.
Chemical Peels: Chemical peels are topical agents that remove the top layer of skin. While they have been shown to be effective, they may also increase the severity of symptoms and cause irritation to the skin.
Laser Treatment: Similar to chemical peels, laser treatment can be effective in treating melasma; however, it can also cause skin irritation and discomfort.
Compounded Topical Creams: Topical creams have vast combinations of hydroquinone, steroids, and retinoids that can help to clear and mitigate melasma symptoms. The exact formulation will depend on the individual patient and their current topical needs. Common ingredients include:
- Tretinoin: Tretinoin is a form of retinoid, and it is used to speed up the skin cell turnover rate. Due to the faster-paced removal of dead cells, new cells are able to form quicker, which allows less time for melasma to develop.
- Hydroquinone: Hydroquinone works to prevent melanin production by impairing the tyrosinase enzyme. This is one of the most common and effective treatments for individuals observing melasma.
- Kojic Acid: Kojic acid, much like hydroquinone, inhibits tyrosinase enzymes to slow melanin production in the skin.
- Hydrocortisone: Hydrocortisone is a corticosteroid that can help to prevent skin color pigmentation variance; however, the primary purpose is to decrease inflammation. Hydrocortisone is typically used in conjunction with another lister treatment, as many medications can increase skin inflammation.
- Azelaic Acid: Azelaic acid is another solution that is used to decrease melanin production. This treatment has been shown to have fewer side effects than hydroquinone. A 20% dose of azelaic acid is equivalent to a 4% hydroquinone dosage.
- Vitamin C: The primary use for vitamin c to help with melasma is inflammation and irritation decrease.
- Tranexamic Acid: Tranexamic acid is a topical treatment that has been seen to help decrease bodily melasma patches
- Niacinamide: Niacinamide does not impair melanin production; rather, it affects melanocyte transfer, which helps with skin pigmentation.
- Microneedling: It has been shown that melasma treatment in combination with micro-needling can enhance the effectiveness of said treatments. The needles make small punctures to the skin, which allows medications to enter one’s pores more efficiently.
OTC Medicine VS. Prescription?
Many of the treatments above that are made in topical form can be purchased OTC, with the exception of hydroquinone which is only available by prescription. Many of the other treatments are provided in lower strengths at many drug stores or generic pharmacies. Any individually tailored formula can be crafted at a compounding pharmacy, and patients who have not seen effective recovery with TOC medications should consult a compound pharmacist. The main difference between OTC and prescription treatments is the strength, as more robust solutions are only available to patients after being prescribed by a doctor.
The skin is very sensitive and plays a crucial part in the makeup of humans; thus, tailoring and customizing the right compounded formula for you and your skin type is essential. It is advised all patients consult a compounding pharmacist to increase the chances of effective and efficient melasma treatment.
