Hormonal Pigmentation/Melasma

Melasma, also known as hormonal pigmentation, is a considerable problem for many women. It is a chronic skin condition that occurs on the face in the form of brown patches and is a dynamic (active) condition that needs lifelong management.

Clínica Privé Tips:

• Avoid sun exposure to your face, neck and décolleté and wear a protective hat when outdoors for extended periods to further block these rays.
• Use a broad-spectrum sunscreen with SPF 30+ (HELIOCARE GEL) to block the UVA rays every day to help prevent melasma/hormonal pigmentation.
• In addition your sunscreen you should also apply an anti oxidants such as DAILY POWER DEFENSE containing Vit C, Vit E , Ferulic and Phloretin to protect against infra red A.
• At least 5 mls/1 teaspoon of sunscreen should be applied daily to the face, neck and décolleté twice a day to prevent melasma/hormonal pigmentation.
• Taking an oral anti oxidant supplement such as HELIOCARE daily is clinically proven to raise one's level of resistance to the sun and also helps to reduce the melanin content in the skin down the line.
• A daily high dose of 4000 mg of MSM per day will increase intra cellular Glutathione and help reduce pigmentation in the Skin.
• As melasma is a dynamic condition and needs to be managed daily and indefinitely, one day of unintentional sun burn can set you back.
• At Clínica Privé we recommend that you avoid hot baths, Bikram Yoga, steam saunas, tanning beds and dry saunas as they can cause excessive inflammation and may aggravate hormonal pigmentation.
• A perfect antidote to dull, pigmented skin in the winter months is one of Clínica Privé's signature facial: the Brightening/Lightening facial with transdermal brightening agents. This pampering facial is a four-in-one treatment and is exciting everyone who tries it out as its versatile, suits everyone and leaves skin tighter, brighter, younger and fresher.

What is the cause of increased pigmentation and darkening of the skin?
There are many possible causes of pigmentation disorders, which are marked by changes in melanin, the pigment in skin.

How is skin color produced?
The short answer is that melanin-its amount, quality, and distribution-creates human skin color. The slightly longer answer is that melanin is produced within melanosomes, organelles located in the cytoplasm of melanocytes (skin cells in the basal layer of your epidermis). The number of melanocytes in human skin is the same in people of all races; in darker-skinned individuals, though, the melanosomes are larger and contain more melanin. Once melanin is produced, melanosomes migrate to the melanocytes' dendrite tips, where they come into contact with keratinocytes, skin cells closer to the surface of the epidermis. The final stage of the pigmentation process, however, wherein melanin is transferred from the melanocytes to keratinocytes, is still poorly understood.

What causes Hormonal Pigmentation/Melasma?

• UVA rays are a stimulant for melanin (brown pigmentation) to develop on the skin, and unfortunately can even penetrate through car window glass.
• Any change in hormonal status with higher levels of estrogen is thought to trigger and aggravate the condition (i.e. birth control pills and pregnancy). Discontinuing the use of contraceptives rarely clears the pigmentation and it may last for many years after discontinuation.
• After pregnancy Melasma (chloasma) or pigmentation usually clears within a few months of delivery but may persist indefinitely.
• However many women without these risk factors also develop melasma.
• Any activities that cause Intense heat to the face (from steam showers, hot closed environments, sitting on the beach even under cover and with full sun protection, etc.) cause inflammation, which is a powerful stimulator of melanin.
• It is more prevalent in darker-complexioned individuals though persons of any race can be affected due to the intense sun.
• Melasma is seen most frequently in young women but can be seen in men.

Where does Melasma appear on the face?

• Centro Facial (forehead),
• Malar (cheekbones) and
• Mandibular (jawline).

What are the different types of Melasma? (This describes how deep the pigment is in the skin and how to treat it)

• Epidermal melasma is the most common form and is easily treated with a combination of superficial chemical peels, Vbeam Photofacials or Photo Genesis procedures.
• Dermal melasma: If the melanin has leached into the dermis, this is known as dermal melasma. The deeper the pigment is and the more difficult it is to treat. Dermal melasma is not treated with superficial peels and is best treated with mid dermal peels such as a Clínica Privé's OBAGI Blue Peel, Cosmelan, Dermamelan or injected mesotherapy with Tranexamic acid to penetrate into the dermis to reach the pigment.
• Mixed Epidermal-Dermal melasma is a combination of the above and is treated the same way as dermal melasma.

What is hormonal pigmentation, also known as melasma?
Melasma, also known as hormonal pigmentation. It is a chronic skin condition that occurs on the face in the form of brown patches and is a dynamic (active) condition that needs lifelong management. Its incidence is much higher in Asian and darker-skinned individuals than in fair-skinned people.

What appearance does Hormonal pigmentation/Melasma have?
Pigmentation disorders such as melasma or chloasma (during pregnancy) arise from increased melanin in the lower layers of the skin and increased free melanin in the skin. Hormonal pigmentation is usually brown with a non-distinct border, and is usually found symmetrically on the face or jawline. Melasma can appear on the central facial areas such as the cheeks, moustache, and forehead areas. Melasma affects both men and women, though it is more frequent in women (up to 30% may be affected) and usually starts to appear from the age of 28 years onwards.

What is the cause of Hormonal pigmentation/Melasma?

• The pathophysiology of melasma is uncertain. In many cases, a direct relationship with female hormonal activity appears to be present because it occurs with pregnancy and with the use of oral contraceptive pills and HRT/ hormone replacement therapy.
• After pregnancy Melasma (chloasma) or pigmentation usually clears within a few months of delivery but may persist indefinitely.
• Any change in hormonal status with higher levels of estrogen is thought to trigger and aggravate the condition (i.e. birth control pills and pregnancy). Discontinuing the use of contraceptives rarely clears the pigmentation and it may last for many years after discontinuation.
• However many women without these risk factors also develop.
• Other factors that may be implicated are progesterone (the Mirena), photosensitizing medications such as tetracyclines or anti psychotic medication or medical conditions such as mild ovarian or thyroid dysfunction and dysbiosis.
• Other possible causes could probably include genetic predisposition and exposure to ultraviolet light. Visible light which emits infrared A (sunlight, TVs, computer screens, fluorescent lights, hair dryers, clay ovens) and excessive heat which causes inflammation (such as saunas and steam baths).
• Stress may also produce certain hormones that worsen melasma.
• UVA rays are a stimulant for melanin (brown pigmentation) to develop on the skin, and unfortunately can even penetrate through car window glass.
• Any activities that cause intense heat to the face (from steam showers, hot closed environments, sitting on the beach even under cover and with full sun protection, etc.) causes inflammation which is a powerful stimulator of melanin.
• Melasma is more prevalent in darker-complexioned individuals though persons of any race can be affected due to the intense sun exposure.
• Melasma is seen most frequently in young women from the age of 28 years but can be also be seen in men.

How is hormonal pigmentation/melasma managed at Clínica Privé?

• Hormonal pigmentation/ Melasma is a dynamic, chronic condition, which has to have ongoing management by applying a pigment inhibitor daily. We have numerous Cosmeceutical and non prescription topical Brightening / pigmentation products at Clínica Privé
• Without the strict avoidance of sunlight and the continued use of home topicals mentioned above to downregulate the enzymes responsible for making pigment, potentially successful treatments for melasma and pigmentation are doomed to fail.
• To prevent increased Hormonal Pigmentation and PIH (Post inflammatory Hyperpigmentation) before and after any peel or Laser procedure, pretreatment for a period of 2 to 4 weeks is recommended to downregulate the enzymes responsible for making pigment.
• Our superficial peeling treatment of choice at Clínica Privé is the Beta Melanostop peel which is a 4 peeling combination of salicylic acid, rescorcinol, phytic and azelaic acid combined with a transdermal brightening mesotherapy.
• Prescription skin-bleaching agents are extremely helpful in lightening melasma and maintaining skin-lightening improvements and may be prescribed.
• In addition, THE CONTINUED USE OF RECOMMENDED PIGMENTATION PRODUCTS IS MANDATORY AFTER ANY PEEL / LASER procedure.
• SPF of 50 MUST be applied twice daily.
• Any laser procedure such as fractional laser that causes excessive redness and inflammation should be avoided as there may be aggressive rebound hormonal pigmentation a few weeks/ months later especially if NO post treatment depigmentation products are prescribed.
• At Clínica Privé we recommend that you avoid hot baths, Bikram Yoga, steam saunas, tanning beds and dry saunas as they can cause excessive inflammation and may aggravate hormonal pigmentation.

What other Clínica Privé Brightening agents may be prescribed for you by the Skin Renewal doctors?
Many all-natural, topical skin-brightening agents have been found to be quite beneficial in lightening hyperpigmented areas of the skin. These include alpha arbutin, as well as kojic acid, azelaic acid nicotinamide and Liquorice root (Glycyrrhiza glabra).

Topical applications of natural, fruit-derived alpha-hydroxy acids, including glycolic acid, have been extremely beneficial in combination with the aforementioned bleaching agents. For enhanced results, these products should be used in conjunction with exfoliation treatments such as peels and transdermal pigment lightening Mesotherapy.

The following is a list of skin care ingredients to AVOID due to worsening melasma pigmentation and dark spots.
Oestradiol, oestrogen, genistein ,black cohosh, chasteberry, hops, red clever, soy, wild yams.

Why are certain hormonal pigmentation conditions so difficult to resolve?

• Pigmentation present for more than 2 years may be more resistant to treatment as dermal pigment may be present and this may need transdermal therapy with TA (Tranexamic acid) or deeper peels Cosmelan or Dermamelan depigmentation treatments which are suitable on all Skin types.
• Dermal pigment is caused by the melanocyte distributing pigment/ melanin into the dermis instead of the epidermis.
• This dermal pigment may take longer to resolve than epidermal pigment. The source of the dermal pigment is the epidermis so if the epidermis can be prevented from making melanin for long periods with home topicals and peel/ depigmentation treatments such as a series of superficial peels, Cosmelan and Dermamelan, the dermal pigment will not replenish and will slowly resolve... but this may take months.
• Normal SPF sunblock protect against UVA and UVB but NOT AGAINST infrared A.
• Without the strict avoidance of sunlight and the continued use of home topicals mentioned above to downregulate the enzymes responsible for making pigment, potentially successful treatments for melasma and pigmentation are doomed to fail.

What is infrared A?

• Infrared A, a relatively new discovery, is a deep dermal ray which causes accelerated ageing.
• Infra red A is found in ANY visible light that emits heat such as sunlight, computer screens, fluorescent lights, heaters and even hair dryers.
• Normal SPF 50 sunblock protects against UVA and UVB but does NOT protect AGAINST infra red A.
• One is only 56 % protected with a good SPF 50 sunblock.
• If one applies a topical anti oxidant such a Vit C, Vit E , Ferulic and Phloretin, 96 % sun protection can be achieved
• Only topical antioxidants such as Vit C, Vit E , Ferulic and Phloretin can protect against infra red A

How do the oral anti oxidants such as Heliocare protect one's Skin internally?

• For continued sun protection and to maintain results, oral supplements such as Heliocare (Polypodium Leucotomas) together with MSM with Vit C can be taken orally to increase ones resistance to the sun.
• In addition Pycnogenol and Polypodium Leucotomas are powerful anti oxidants that stop the enzyme that breaks down collagen (MMP) and protect against infra red A, which is present in the light from sun exposure, computer screens, fluorescent lights etc.

How do we mange resistant Hormonal pigmentation/ Melasma at Clínica Privé?

• After a series of 4 to 6 in office medical peel treatments combined with home topicals, the topical products need to be applied indefinitely and one of the above mentioned topicals is recommended. These can be alternated over time.
• In addition, if there no improvement after the 6th treatment of superficial peels and topical products, Cosmelan or Dermamelan or Injected Tranexamic acid mesotherapy treatments are recommended to treat dermal melasma and PIH which has been present for more than 2 yrs.
• If the melanin has leached into the dermis, this is known as dermal melasma.
• The Laser Genesis procedure can be done in all skin types as it targets dermal pigment by heating up the melanophage ( which contains the melanin) trapped in the and aids the "release" of the trapped dermal pigment so it can move up to the epidermis where it can be exfoliated with normal epidermal renewal. Laser genesis also "polishes" the skin and improves fine lines, wrinkles, pores and texture
• For all peels prescription creams such as Retin A or retinols must be stopped stop 3 days before each treatment and restarted 3 days after the peeling process.

What are new pigmentation peptides developments in the treatment of Melasma/ Hormonal pigmentation?
1. ZO MEDICAL´s MELAMIN, an advanced pigmentation program which addresses hyper-pigmentation by reducing melanin at several points in its production, as opposed to just one point as with other treatments.
2. Mixing RETAMAX & MELAMIN has Oligopeptide 34 plus 3 new novel pigmentation peptides added to the formula which offers excellent results in combating epidermal and post inflammatory hyper- pigmentation (PIH).
An added benefit is that the combination of peptides used in the range offers anti-ageing benefits to the skin as they stimulate collagen producing cells. By adding the supplement HELIOCARE, the melasma will be reduced further by 37% within 4 to 6 weeks of use.
3. BRIGHTENEX by ZO MEDICAL Brightening System is a revolutionary multi-faceted system that dramatically improves the appearance of hyperpigmentation tolerably and without the side effects associated with prescription Hydroquinone or retinoids. An innovation in skin brightening technology, this Brightening System uses a decapeptide to target existing hyperpigmentation and to prevent its recurrence. BRIGHTENEX products are proven to be powerful but gentle on skin. BRIGHTENEX is ideal for all skin types.

The following is a list of skin care ingredients to USE if you have Melasma;
arbutin, bearberry, cucumber extract, hydroquinone, kojic acid, licorice extract, magnesium ascorbyl phosphate, mulberry extract, niacinamide, retinol, resorcinol, beta hydroxyl acid, vitamin c, oligopeptide 34,

What other forms of pigmentation conditions are there?

• The most common localized pigmentation disorder affecting the skin are ephelides, more commonly known as freckles. Freckles appear as flat brown pigmentation in sun-exposed areas, usually on the face. They are much more common in fair-skinned individuals, and a propensity to have freckles is an inheritable condition. The degree of pigmentation in the skin changes according to the amount of ultraviolet light exposure, so that freckles usually darken in the summer and lighten in the winter.
• Another very common skin disorder is known Post Inflammatory Hyperpigmentation PIH. The underlying mechanism is unclear, but may involve inflammatory mediators such as prostaglandins and leukotrienes. While the causes and clinical presentation of post-inflammatory hyperpigmentation can vary, they are usually secondary to a traumatic incident to the affected area of the skin such as acne, dermatitis, eczema or any form of inflammation of the skin. Sun exposure can worsen this condition. Topical therapies and treatments as mentioned above in combination with sunblock may help this condition.
• Solar lentigos/sun spots appear as brown lesions (about 1 centimeter in diameter), typically on the face and hands. Both acute and chronic UV exposure can cause lentigos. While they rarely appear on patients under fifty, they are not caused by age -- sun-protected skin is not affected, even in elderly patients. Solar lentigos are completely preventable with sun avoidance and daily sunscreen use. Finally, whether solar lentigos are treated or untreated, patients should undergo routine skin exams, as they may be at greater risk for skin cancer.