Pigmentaion & Melasma Treatment in Kampala

Types of Pigmentation:

• Melasma: Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

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• Who Does it Affect?

  1. Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.
  2. Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to the sun.
  3. Women with a brown skin type who are living in regions with intense sun exposure are particularly susceptible to develop this condition.
  4. People with a family history of melasma are more likely to develop melasma themselves.
  5. Birth control pills may also cause melasma.
  6. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called Chloasma or the “mask of pregnancy.” Melasma may disappear after pregnancy; it may remain for many years, or a lifetime.
  7. Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes in the skin. People with skin of color have more active melanocytes than those with light skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.
  8. It may also be noticed in apparently healthy, normal, non-pregnant women where it is presumed to be due to some mild and harmless hormonal imbalance.
  9. Any irritation of the skin may cause an increase in pigmentation in dark-skinned individuals, which may also worsen melasma. Melasma is not associated with any internal diseases or organ malfunction.

• How is Melasma diagnosed? Because melasma is common and has a characteristic appearance on the face, most patients can be diagnosed simply by a skin examination with a Woods lamp. Occasionally a skin biopsy is necessary to differentiate melasma from other conditions.

• Melasma Treatment: While there is no cure for melasma, many melasma treatments have been developed.

  1. Sunscreens are essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. An SPF 25 or higher should be selected.
  2. In addition, Antioxidant solutions, physical sunblock lotions, and creams may be used to block ultraviolet radiation and visible light are one solution to melasma treatment. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors. A significant amount of ultraviolet rays is received while walking down the street, driving in cars, and sitting next to windows.
  3. Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as this may worsen melasma.
  4. If melasma develops after starting birth control pills, it may improve after discontinuing them.
  5. It cab be treated with skin lightening creams while continuing the birth control pills. A variety of creams are available for the treatment of melasma. These creams do not “bleach” the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells. Typically, these creams contain Hydroquinone, which inhibits the formation of new pigment. Bleaching creams must be applied for at least 6 months to obtain a worthwhile lightening of pigmentation.
  6. Creams containing Tretinoin and Glycolic Acid are used in combination with hydroquinone to enhance the depigmenting effect.
  7. Chemical peels and laser surgery with potent lasers such as the Institute laser (Q switched Nd YAG laser) may help melasma, but results have not been consistent. These procedures have the potential of causing irritation, which can sometimes worsen melasma. Generally, they should only be used by a dermatologist in conjunction with a proper regimen of bleaching creams and prescription creams tailored to your skin type.