There are different types of spots on the skin: melasma, or chloasma, actinic lentigo or solar lentigo, senile lentigo, or age spots, post-inflammatory spots, and often acne scars. In a future article, we will present the various possible treatments that can be administered at home or in the office to fight against this excess of pigmentation. What follows in this article concerns a skin problem commonly treated in medical practice: melasma. This condition, which affects mainly women and predominantly black and dark-skinned women, frequently leads to requests for dermatological care.
Brown spots-Melasma: a skin problem
Melasma is characterized by symmetrical temporary hyperpigmented brown spots located on the face. Although the exact origin remains unknown, several risk factors are identified: high phototype (skin color: dark), genetic predisposition, sun exposure, pregnancy and hormonal treatments.
Numerous studies agree that melasma appears with the first exposures to the sun and that it gradually worsens during the summer period.
Why is there hyperpigmentation?
The skin has an identical number of cells (melanocytes) producing brown pigment (melanin), which is responsible for skin colour and the colour of a tan. But when exposed to the sun, there is an excessive increase in the synthesis of melanin because of over-excited melanocytes. The treatments therefore aim to regulate this excess.
What are the causes of melasma?
Melasma is a common hyperpigmentary disorder appearing at the level of photo-exposed areas, and more often affecting women with dark skin.
Its pathogenesis is not entirely clear, but it is considered the main consequence of hormonal changes in genetically predisposed women.
Some triggering factors have been highlighted:
- Sun exposure;
- The process of low-level inflammation of the skin or inflammaging;
- The use of bad cosmetics;
- Photosensitive drugs.
A correlation between oxidative stress and melasma
In light of recent observations, melasma could be considered a pigment disorder caused by photoaging affecting genetically predisposed individuals. Recently, a correlation has been established between melasma and the level of oxidative stress in a clinical study conducted in patients with melasma (Choubey V. et al., Int. J. Dermatol., 2017).
The gender and age of patients do not give rise to significant changes in the level of oxidative stress. In contrast, antioxidant defence activities and skin cell constituent damage appear significantly higher in melasma patients than in patients without melasma.
Considering the role of free radicals in the pathology of melasma, an effective strategy would be to protect the body from oxidative stress.
How to remove brown spots on the face?
The treatment of cutaneous hyperpigmentation is often a difficult and time-consuming process. Many depigmenting agents have been studied in order demonstrate their efficacy and safety. These depigmenting agents are likely to reduce cutaneous hyperpigmentation or even normal skin pigmentation. In 90% of cases, they act on melanocytes at different functional stages, and are for the most part considered as drugs because of their dermatological and systemic impact.
There is yet no miracle solution, which alone would treat melasma. Even if it does not cause a health problem, this pathology is related to a very important aesthetic problem. It is therefore important to be followed by a specialist physician who, depending on your skin type, will apply the optimal treatment.
Towards a combined approach for melasma at the dermatologist
In general, the prescription of a depigmenting treatment is based on combinatorial strategies: the synergy of three approaches; topical, oral and dermato-aesthetic procedures maximize the chances of treating skin hyperpigmentations.
The depigmenting shock treatment: the Kligman trio, prepared with hydroquinone, retinoic acid and corticosteroids.
This preparation has been in frequent use since the sixties as a lightening product. Hydroquinone acts as an alternative substrate for tyrosinase (the enzyme responsible for the production of melanin). Hydroquinone reduces the oxidation of tyrosine and inhibits melanogenesis, damaging hyperactive melanocytes and melanosomes. Vitamin A or retinoic acid accelerates epidermal turnover and reduces the melanin content. Corticosteroids will regulate the inflammation that stimulates melanogenesis.
If the Kligman trio fails, chemical peels are an alternative, especially those containing glycolic acid (20 to 70%). They are to be used with depigmenting agents such as hydroquinone to prevent post-inflammatory pigmentations.
The complementarity of the oral route can reduce the side effects of these treatments and improve their efficacy. The contribution of antioxidants acts on inflammation by reducing the free radicals generated by environmental stresses. These stresses are primarily responsible for adverse effects.
The oral route, a natural approach to support the treatment of melasma
Very recently a molecule called GliSODin from a rich mixture of melon and wheat, was used in a clinical study on melasma to evaluate the synergy of action of the oral route with depigmenting creams and sun screens.
Under dermatological control, the results showed a visible reduction by three of brown spots compared to using a depigmenting cream used alone.
90 % Ninety % of people who used GliSODin General Health would recommend its use to their loved ones.
This work with GliSODin encourages the oral use of natural products to help support the body in a dermatological-aesthetic treatment. (For more information)