Melasma Mastery

Shriyal Sethumadhavan looks at the multifaceted aspects of melasma and how a holistic approach can help individuals achieve clearer and more radiant skin.

Melasma is a complex skin condition characterised by hyperpigmented patches, often occurring on the face. While it can affect anyone, it is particularly common among women, especially during times of hormonal fluctuations like pregnancy or while taking oral contraceptives.

Hormones and melasma

Pigmentation, especially melasma, is multifactorial, with genetic influences, ultraviolet (UV) light exposure, and photosensitive creams being common culprits, explains Dr Padmavathi Surapaneni, Dermatologist, Pragna Skin and Laser Clinic. “However, hormones play a significant role in exacerbating pigmentation concerns.”

“Hormones affect the melanin deposition on the skin,” says Dr Shefali Trasi Nerurkar, Consultant Dermatologist, Dr Trasi Clinic and La Piel Skin Clinic. “Various hormones like estrogen, thyroid-stimulating hormone, adrenocorticotrophin, and melanocytestimulating hormones influence the activity of the enzyme tyrosinase. This enzyme leads to the production of melanin in the skin. Thus, any hormonal fluctuation in the body leads to more melanin production and more hyperpigmentation on the skin. Melasma is caused mainly in pregnancy when there are major hormonal changes in the woman’s body.”

Dr Padmavathi continues, “Estrogen, progesterone, and melanocyte-stimulating hormones (MSH) are increased during pregnancy. Estrogen, in particular, increases the expression of melanocortin Type 1 receptors in melanocytes, which are involved in pigmentation. Interestingly, even in nulliparous women with melasma, estrogen levels may be normal, but increased estrogen receptors are observed. Additionally, postmenopausal women receiving progesterone supplementation have been shown to develop melasma, while estrogen alone does not induce this condition.” She further underscores the link between thyroid function and melasma, noting, “Patients with thyroid exhibit a fourfold increase in melasma, emphasising the intricate relationship between hormones and skin pigmentation.”

Treating melasma

Elaborating on aesthetic treatments for Melasma is Dr Shefali. Turning to its management, she highlights the role of aesthetic treatments: “Peels and lasers are valuable tools in addressing melasma,” she explains.

Speaking of peels, she adds: “Chemical peels, such as glycolic, jessner, retinol, ferulic, and TCA peels, can improve the epidermal component of pigmentation. They work by causing controlled epidermal dyscohesion and subsequent regeneration, effectively removing epidermal melanin from keratinocytes.”

On her part, Dr Padmavathi says, “Peels are effective in enhancing the epidermal aspect of pigmentation. However, it is not advisable to use deep peels for addressing dermal pigmentation concerns in individuals with darker skin tones. Chemical peels create controlled epidermal dyscohesion, which, in turn, promotes regeneration. This process aids in removing epidermal melanin from keratinocytes, preventing melanosome transfer to keratinocytes, and ultimately improving pigmentation. Achieving full clearance may require multiple sessions.” Her list of promising options for peels include glycolic, jessner, Retinol, ferulic, and TCA peels. Combining and using sequential peels can yield superior results.

On lasers, Dr Shefali says, “These target the dermal component of melasma. Laser therapies like IPL, low-intensity Q-switch lasers, and non-ablative fractional lasers are commonly employed. These treatments induce photothermolysis, fragmenting melanosomes and aiding in clearance. Fractional non-ablative lasers create microthermal zones that expel necrotic debris, including pigment, from basal cells.”

Laser and light therapy utilised as the third line of therapy, prove effective in addressing the dermal component of melasma, points Dr Padmavathi. “Commonly employed lasers in treating pigmentation and melasma include IPL, low-intensity Q-Switch lasers, and non-ablative fractional lasers.” She says that Q-Switch lasers, when administered in low doses, trigger sub-lethal damage to melanisomes, causing their fragmentation, and thus aiding in clearance through photothermolysis. This typically necessitates multiple sessions. The fractional non-ablative 1550 laser is approved by the US FDA for melasma treatment. These lasers generate microthermal zones, leading to the extrusion of necrotic debris, including pigment from basal cells. Viable keratinocytes contribute to the early stages of healing. Furthermore, IPL, when used with pigment filters ranging from 500 to 590, delivers promising results in pigment therapy.

Dietary strategies

Elaborating on the role of nutrition in managing melasma is nutritionist Dietician Vidhi Chawla, the creator of Fisico Diet and Aesthetic Clinic. She says, “When our hormones go through changes, it can trigger the development or worsening of melasma, leading to dark patches on the skin. These hormonal shifts can increase the production of melanin, the pigment responsible for skin colour.”

Elaborating on dietary influence, she lists the following:

• Antioxidant-rich foods: Foods with antioxidants, like fruits and vegetables, help protect the skin. Antioxidants, such as vitamins C and E, help shield the skin from damage caused by the sun and harmful molecules in our bodies.

• Vitamin D: Having enough vitamin D is crucial for healthy skin. Not getting enough of this vitamin can make skin problems, like melasma, worse. You can find vitamin D in foods like fish, fortified dairy products, and by spending some time in the sun.

• Zinc: Zinc is important for the skin, and it can help control melanin production. Foods like lean meats, nuts, and whole grains are good sources of zinc.

• Polyphenol foods: Foods with polyphenols, like green tea and dark chocolate, have antioxidants that can reduce skin inflammation linked to melasma.

• Stay hydrated: Drinking enough water keeps your skin hydrated and helps get rid of harmful substances from your body, which can lead to better skin health.

Furthermore, Dietician Vidhi shares the following dietary recommendations for melasma that dermatologists can consider suggesting to their clients:

• Balanced diet: Eating a mix of fruits, vegetables, lean proteins, and whole grains gives your skin the nutrients it needs to stay healthy.

• Sun protection: Besides eating well, it is essential to protect your skin from the sun. Use sunscreen, wear protective clothing, and avoid too much sun exposure because sunlight can make melasma worse.

• Get expert advice: It is also a good idea to recommend talking to a dietitian, who can create a personalised eating plan that suits your specific needs and supports your melasma treatment.

In conclusion

Proper nutrition can have a positive impact on skin pigmentation, especially when dealing with melasma during hormonal changes. By including antioxidant-rich foods, maintaining adequate vitamin D and zinc levels, and staying hydrated, one can help manage melasma and promote healthier skin.

Combined with sun protection and guidance from a dietitian, these dietary recommendations can support dermatological treatments and contribute to clearer and more even-toned skin.