Treatments for Pigmentation Problems at the Cranley Clinic

What is the difference between age spots and melasma?


Melasma:

  • Light to dark brown pathes usually seen on the forehead, cheecks, chin, upper lip
  • Very symmetrical in appearance on both sides of the face
  • Discoloration may be dense pigment and may lie on the epidermis (upper layer of skin), dermis (lower layer of skin), or combination of both
  • Linked to hormonal changes and considered a chronic, recurring condition
  • Sun exposure may exacerbate condition
  • Use of laser remains controversial in treatment

 

Age Spots (sun spots, freckles, lentigines):

  • Appears randomly on all areas of the face and other sun-exposed sites e.g. back of hand
  • Usually not symmertrical, may be patchy or scattered
  • May be associated with other signs of photodamage e.g. textural changes to the skin such as lines or wrinkles
  • Directly linked to sun exposure (not to hormonal changes)
  • Can often respond well to lasers
  • Not considered a chronic condition

 

Melasma is a chronic, acquired, pigmentary skin disorder characterised by symmetrical, brown pigmentation that usually affects the face. The majority of cases are seen in women and can result in considerable social and emotional stress to the sufferer. It usually develops between the age of 20-40 years, and is commoner in darker skin types. There are a number of recgonised triggers including sun exposure, pregnancy, hormonal treatments (combined oral contraceptive pills, intrauterine devices, implants), certain medications, and an underactive thyroid gland. 

Melasma can be recurrent and refractory which makes it difficult to treat. General measures should include rigorous, high factor, broad-spectrum sun protection throughout the year (SPF50+) and avoidance of hormonal contraception, if possible. There are a large number of topical treatments available which aim to prevent new pigment formation e.g. hydroquinone, azelaic acid, kojic acid. Regular chemical peels can also be used to remove pigment in the upper layers of the skin. 

There are a large number of laser treatments that have been tried for melasma (Q-switched Nd:YAG, Q-switched Alexandrite, pulsed dye laser, and various fractional lasers). Their use remains controversial and should be restricted to those cases unresponsive to creams to chemical peels. The main problem with the use of lasers is the development of post-inflammatory hyperpigmentation. This is temporary or permanent escess pigmentation that can develop in skin following either injury (e.g. by laser) or an inflammatory skin disorder, and like melasma, occurs more frequently in darker skin. In an ideal world, a laser would only destroy melasma  pigment in the skin but leave the other normal skin cells alone. In actual practice, it can be difficult to produce reliable and predictable results. 

At the Cranley Clinic, we have a highly experienced team of broad-certified dermatologists and skin specialist physicians that are able to discuss in detail the treatment options available to you for pigmentation problems in the skin. Some pigment dark spots can be a sign of skin cancer and our expertise and treatments are important for accurate disgnosis before treatments. We can offer a range of doctor-led chemical peels that provides excellent results for melasma.