Dealing with skin pigmentation
As a dermatologist, I have tackled melasma (pekas). Each dermatologic patient is different and most skin and hair problems should be dealt with as a case in progress that needs to be regularly assessed and followed up individually. I’ve seen very good results in most patients, but there are still some who will not get an excellent outcome like the others.
Many women have melasma or hyperpigmentation at some point in their child-bearing lives. Mimi first had this condition when she got pregnant with her first child. Her obstetrician assured her that it was “the mask of pregnancy” and would go away once Mimi gave birth. It did.
But about six months after giving birth, Mimi started taking birth control pills. She didn’t notice anything about her skin until about seven months, and after that, she started to notice this little discoloration in a mustache pattern above her upper lip. Mimi went to my clinic and I told her this was melasma due to the birth control pills she took. I gave her a whitening cream that made her melasma disappear completely.
About a year-and-a-half after this, Mimi stopped taking birth control pills and got pregnant with her second child. She had melasma again. After she gave birth, the hyperpigmentation went away just like the first time. Mimi eventually decided not to take birth control pills and just explore other birth control methods. But unfortunately, she suffered hair loss after she went off the pill, and acne started appearing on her face, back, and chest. She also started manifesting signs and symptoms of premenstrual syndrome (PMS). PMS refers to the physical and emotional symptoms that occur one to two weeks before a woman’s period. Symptoms often vary among women and disappear around the start of bleeding. Common symptoms include acne, tender breasts, bloating, feeling tired, irritability, and mood changes. Symptoms are present for around six days. Thus, it became pretty clear that Mimi’s hair, skin, and mood were better when she was on the pill. Of course, being on the pill means that melasma will be back again — actually, in Mimi’s case, it became worse. It spread on Mimi’s forehead, chin, and cheeks. This time, the whitening cream no longer worked like before.
Melasma is derived from the Greek word melas (black), while chloasma is derived from the word chloazin (green) and since the pigmentation is brown-black, melasma is the preferred term. It is more common in those with darker skin types and those who live in areas with intense solar ultraviolet radiation. It is also more common in women than in men, and is rare before puberty, occurring most commonly in women of reproductive age.
The exact etiology of melasma is unknown, but several factors have been implicated. Around 20% to 70% of patients have a family history of melasma. Ultraviolet radiation and visible light cause changes in the lipids of cellular membranes, leading to the generation of free radicals, which stimulate melanogenesis (pigment formation). Elevated levels of estrogen and progesterone (in pregnancy) and pills containing estrogen and progesterone used for prostatic cancer can also induce melasma. However, progesterone may be more important as melasma develops in postmenopausal women who are given progesterone but not when given estrogen supplementation. Estrogens probably stimulate melanogenesis through estrogen receptors present on melanocyte. Other hormones are also implicated such as thyroid hormones. Also implicated is overproduction of MSH (melanocyte stimulating hormone) due to stress, triggering darkening of the skin leading to melasma.
Other causes may include: allergic reaction to cosmetic products; drugs (phenytoin, griseofulvin, and NSAIDs like aspirin, ibuprofen, naproxen) can also cause melasma-like pigmentation; ovarian dysfunction (increase in luteinizing hormones, chronic pelvic inflammatory disease); hepatic dysfunction; parasitoses; nutritional deficiency; neural involvement (trigeminal nerve usually may play a role). Elevation of neural endopeptidase molecules, including nerve growth factor, is a critical factor in the development of melasma.
By knowing the cause, you can prevent and treat melasma more accurately. Clinical expertise in making an accurate diagnosis of melasma is equally important. There are several skin diseases that can mimic melasma and the success of treatment depends on a critical evaluation so as not to mistake melasma for other very similar skin discolorations as the approach to treatment may differ for each particular case. These include: Hori’s Nevus, bluish gray pigmentation located on the bony prominence of the cheeks; Riehl’s Melanosis, reddish brown pigmentation; Poikiloderma of Civatte, reddish brown patches with skin thinning and spider veins within the rash; post-inflammatory hyperpigmentation, pigmentation after an irritation, allergy or injury; drug-induced facial pigmentation; Actinic lichen planus, pigmented small elevated bumps that group together to become larger.
The aim of treatment is to eliminate the already existing pigmentation and to block the newly forming pigments. Many very effective treatment options are currently available for melasma, especially the superficial type, which aim to shorten and simplify the treatment. Newer treatment modalities, together with stronger lightening creams and capsules, are also available now. Successful treatment requires long-term patient compliance because therapeutic effects usually become evident after one to two months.
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For inquiries, call 09174976261, 09998834802 or 263-4094; email gc_beltran@yahoo.com.
