/ drdavinlim
Secrets to achieving flawless skin
www.lasersandlifts.com.au Much more in-depth explanation on ways to achieve healthy radiant skin
Realself reviews:
www.realself.com/find/Australi...
Google + for up to date info. Posted daily.
plus.google.com/u/0/b/1139391...
How to treat pigmentation- melasma.
Otherwise known as chloasma, pigmentation of pregnancy.
Melasma presents as patchy brown pigmentation on sun exposed areas of the face. This condition is more commonly seen in darker skin types, and is more common in females. Though the condition may respond to treatment, it is usually recurrent.
Causes of melasma
The cause of melasma is multifactorial. Genetic predisposition, sun exposure, and hormonal influences all play a role in this condition. Patients of darker skin colour, including Asian, Hispanic, Middle Eastern and Mediterranean cultures are more prone to this condition. Melasma is more common in women and maybe associated with hormonal changes including the oral contraceptive pill, IVF treatment and pregnancy. Ultraviolet (UV) radiation (UVA and UVB) stimulates melanocytes (the pigment producing cells) causing them to produce melanin (pigment).
Clinical Features
Melasma presents as dark patches which may be light brown, tan or even dark brown/black depending on the depth of the pigment in the skin.
Treatment
Photoprotection is the cornerstone of management. Strict and absolute protection with a broad-spectrum sunscreen, covering both the UVB and UVA spectrum is essential. Sunscreens should be applied twice a day.
Cream Treatments: these, together with sun protection form the basis of management.
Hydroquinone HQ 2-8% as a cream of lotion either in a stand-alone formulation or mixed with other active ingredients is the most widely used method to treat melasma. The higher the concentration of HQ, the higher the incidence of irritant dermatitis. Application should always be titrated according to skin sensitivities.
Vitamin A creams including tretinoin can be used as a stand-alone treatment or in combination with other agents. Application should be titrated according to skin irritation.
Ascorbic acid or Vitamin C can be used as adjunctive treatment of melasma. It acts as an anti-oxidant, as well as a pigment-inhibiting compound.
Azelaic acid 20% has been reported to improve epidermal cases of melasma.
Combination topicals: Modified Kligman’s formulation consists of variations in concentration of Hydroquinone, retinoid, and a topical steroid and is considered the gold-standard for melasma management at present.
Chemical peels: superficial peels are preferable to medium or deep peels form melasma given this condition affects those with darker skin.
Glycolic acid peels are the most commonly used agent.
Lactic acid peels may also be used.
Low-strength tricholacetic acid peels
Medium to deep chemical peels should not be used to treat melasma due to a high incidence of complications
Laser and light based treatments: Only certain lasers should be used with conservative settings and are best performed by a dermatologist. Multiple treatments are necessary to see an appreciable benefit. A detailed discussion with your dermatologist about the appropriateness of laser therapy for your melasma is essential.
1064nm Q Switch Nd Yag laser, at low power settings is, to date, the most promising laser for melasma. Several treatments are required over many months to see improvements.
Vascular laser may be used to treat the erythrotelengiectatic subtype of melasma
Non ablative fractional laser is not commonly used, but has been reported in the literature
Ablative Fractional lasers are only appropriate for those with light skin. Complications are high if used in those with dark skin.
Intense Pulsed Light can be effective in some cases of epidermal melasma in lighter skin only. It should be noted that even if they are effective recurrence is usually seen.
Tranexamic acid has been reported for treatment of melasma. Newer Q-Switched picosecond lasers may prove to be more helpful than the current nanosecond Q-Switched technology.
Prognosis
Epidermal melasma has a better prognosis than mixed or dermal melasma but all types are recurrent and require ongoing maintenance therapy.
Melasma associated with pregnancy has the best prognosis, with pigment gradually fading over months. However, subsequent pregnancies often result in recurrences.
Dr Davin Lim, Laser and aesthetic dermatologist.
Brisbane. Queensland. Australia.
Lasers and Lifts.
16 мар 2017
