Melasma, commonly known as cloth, is a challenge faced by many women between 30 and 40 years old, especially those with high phototypes, that is, brown or dark skin. Its prevalence varies between 8.8% and 40%, being caused by factors such as chronic exposure to ultraviolet radiation, visible light, hormonal stimulation and genetic factors. This disorder manifests itself through irregular brown spots on areas exposed to the sun, mainly on the face. Clinically, it presents three predominant facial patterns: centrofacial, malar and mandibular, with the centrofacial being the most common (between 50% and 80%).
To effectively address melasma, it is crucial to establish clear goals in its management: reduce the intensity of the pigment, reduce the area of the spots, prevent their recurrence and improve the quality of life of patients. There are options that include topical depigmenting agents, alone or in combination, to achieve synergy. In addition, measures can be taken to avoid aggravating factors, such as intense exposure to UVA, UVB, infrared and visible light radiation, as well as the use of hormonal contraceptives and photosensitizing drugs.
Photoprotection plays a fundamental role in the treatment of melasma, as visible light has been shown to promote hyperpigmentation in patients with this condition. Therefore, we strongly recommend the daily use of sunscreen agents containing titanium dioxide and zinc oxide. In addition, we encourage changes in habits and the use of accessories such as hats, glasses and umbrellas for complete protection.
As for topical depigmentants, there are several options, including phenolic acid, hydroquinone, retinol, azelaic acid, kojic acid, tranexamic acid, vitamin C, and niacinamide. These topical treatments are our first line of action against melasma, and their effectiveness becomes evident after eight to twelve weeks of continuous use, with safety supported by application studies for up to six months.
In addition to topical treatments, our clinic also offers minimally invasive procedures and high-quality depigmentation products. These procedures accelerate the elimination of melanin without stimulating its production.
For a more comprehensive approach, we consider oral adjuvant systemic agents, such as tranexamic acid, which acts by inhibiting the plasminogen activating enzyme, reducing conversion to plasmin. The dosage varies depending on individual needs, and improvement is usually seen within one to two months. Other agents, such as melatonin and superoxide dismutase, also play an important role in protecting against UV-induced damage and melanocyte stimulation.
In addition to these therapeutic options, there are complementary treatments such as high-frequency ultrasound and micropunctures. High-frequency ultrasound has been shown to reduce UVB-induced hyperpigmentation, and microneedling allows for effective delivery of topical drugs, promoting fibroblast proliferation and the formation of new collagen.
Melasma can significantly impact patients’ quality of life due to its chronic nature and frequent falls. At our aesthetic medicine clinic, we are committed to providing cutting-edge treatments that seek greater depigmentation and prevention of recurrence, thus improving the quality of life of our patients.
Conclusion of the article:
Melasma, known as cloth, is a challenge that affects the quality of life, mainly of many women and in some cases of men. In our clinic we offer different treatments designed to reduce spots and prevent their recurrence.