Melasma is a tan or dark skin discoloration commonly acquired, chronic, circumscribed hyperpigmentary disorder mainly involving sun-exposed areas, especially the face in a symmetrical fashion. The brown or grey-brown patches of melasma appear most often on the cheeks, forehead, nose and chin. The treatment of this condition remains challenging because its causes are poorly understood. Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. Proper counseling, adequate sun protection measures and topical pigmentation agents comprises the first line of therapy. Chemical peels are second in line. Laser and light-based therapies are used in refractory cases, as they may worsen the condition in some cases.
Physical Agents: Sunscreens
Sometimes many cosmeceuticals have physical sunscreens like titanium dioxide, zinc oxide in the same formulation for added benefits.
Medicines: Systemic agents
Oral Tranexemic Acid (TA) has several studies supporting its safety and efficacy. It may best be used as an adjuvant to conventional topical drugs. Other oral agents being studied are procyanidins, pycnogenol, polypodium leucotomos and glutathione.
DRUGS & COSMECEUTICALS:
These are topical pharmaceutical agents that enhance the beauty through constituents that provide additional health-related benefit. In women, Melasma often fades spontaneously after pregnancy or after an affected woman stops taking contraceptive pills. Skin lightening creams can help in curing Melasma. Topical medicines cause skin lightening. Unlike cosmetics which do not alter the structure or function of the skin and have no lasting impact on skin. These agents selectively target hyperplastic melanocytes to inhibit key regulatory steps in melanin synthesis.
Hydroquinone (HQ) - Phenolic compounds
Hydroquinone (HQ) the prototype depigmenting agent inhibits tyrosinase. HQ is used alone as 2 to 5%, or combination of 4% HQ, 0.05% tretinoin and 0.01% Fluocinolone Acetonide. After few weeks of daily regimen, it can be used intermittently to prevent relapse and has shown marked improvement in melasma.
1. Kojic acid : A fungal product used at concentrations from 1% to 4% shows good results for melasma.
2. Azelaic acid Strengths of 10 to 20 % are used, and it doesn't alter color of unaffected skin.
3. Arbutin : Arbutin, aberry plant derivative of HQ is less melanotoxic. Studies show it is less effective than kojic acid. Deoxyarbutin, a derivative, is safer and more effective.
4. Vitamin CA naturally occurring antioxidant, reducing agent, inhibiting melano-genesis, is one of the commonest component of many cosmeceuticals. It is unstable and its penetration into the skin is low. Hence, stable esterified derivatives like magnesium-ascorbyl-phosphate (MAP) can be used in concentrations of 1 to 10%.
5. Alpha tocopherol Vitamin E is a lipophilic antioxidant commonly used in cosmeceuticals products, with proven photo-protective effects. Combination with vitamin C has better results.
6. Niacinamide Physiologically active amide of niacin (vitamin B3). Daily use of niacinamide with sunscreen show better results, hence is an ingredient of many popular sunscreens.
Plant Derivatives & extracts:
There is arising trend towards naturally derived extracts for treating hyperpigmentation. Plant extracts like Broussonetica kazwoki, B.Papyrifera, Cornus officinalis, Rhus javanica and Pinus densiflora inhibit tyrosinase and DOPA oxidation.
Few other Plant extracts used are:
1. Grape Seed extract - Oral intake for 6 month improved Melasma.
2. Orchid extract -Has been found to have efficacy similar to vitamin C
3. Aloesin a natural derivative of aloevera is an experimental product
4. Pycnogenol - An antioxidant anti-inflammatory from French pine used in melasma.
5. Aloe vera extract - Is an ingredient of various market preparations. Contains procyanidins, polyphenols and cinnamic acid. Oral dosing improves melasma
6. Marine algae extract- marine algae extracts showing few extracts inhibited tyrosinase activity similar to that of kojic acid without any side effects.
6. Cinnamic acid -It is a plant derivative and some studies show greater inhibition of tyrosinase activity compared to hydroquinone (0.5 mmol/L).
7. Flavonoids- Naturally occurring polyphenols with anti inflammatory, antioxidant,antiviral and anti-carcinogenic acid (green tea), ellagic acid (green tea,eucalyptus, strawberry)properties.
8. Coffeeberry and mulberry plant extract - Depigmenting actions of these are not proven.