Hyperpigmentation is a general term used for darkening of the skin.
This is where dark marks occur on the skin as a result of trauma or injury to the skin. Common causes include acne, insect bites, burns and friction in the skin folds. Various products are available which contain ingredients such as azelaic acid, arbutin, niacinamide and liquorice extract.
Melasma is caused by an overproduction of melanin by the pigment cells i.e. melanocytes. Melasma has the following causes:
Patient’s Skin Type: It tends to occur in people with a darker or move olive skin;
Hormonal Factors: Pregnancy or the oral contraceptive will often bring about melasma;
Sun Exposure: Just one day of excessive sun without a sunscreen can produce melasma.
There are essentially two types of Melasma:
Epidermal melasma is where the pigment is situated in the top layer of the skin i.e. the epidermis. This form of melasma may disappear with sun avoidance, sun protection and the daily use of a high factor, broad-spectrum sunscreen. If the melasma is present for a long period time, the pigment may fall through the base membrane zone into the dermis and this called Dermal melasma. This is type of melasma tends to be chronic and more stubborn to treat. You will often get lightening of the pigmentation but usually not complete clearing.
The mainstay of treatment for melasma topical hydroquinone in various concentrations and used in various bases. This is a prescription treatment that can only be given by a medical practitioner. If indicated, Dr Webster's protocol is to start the patient off on a topical hydroquinone mixture, to improve the melasma, and then to slowly wean the patient off the hydroquinone and introduce non-hydroquinone products that contains ingredients such as tranexamic acid, niacinamide, azelaic acid, arbutin, kojic acid and liquorice extract. An example of one such product is Martiderm DSP Bright Ampoules
A very important part of the treatment is sun avoidance, sun protection and the daily use of high factor, broad spectrum sunscreens such as the Heliocare 360º range
Exposure to ultraviolet radiation, visible light and infrared light can make the condition worse because it activates melanocytes in the skin.
As mentioned previously, unfortunately the deep dermal form of melasma tends to be a chronic condition and is therefore more controllable rather than curable.