April 2024

What is melasma? 

Melasma, a common skin condition characterised by brown or greyish-brown patches on the face, can pose unique challenges for individuals with darker skin tones. In this blog post, we'll explore the specific issues faced by women of colour with melasma and delve into the impact of menopause on melasma, providing practical insights and tips for effective management.

Understanding melasma in darker skin

Melasma affects individuals of all skin types, but it's particularly prevalent in those with darker skin tones. It typically presents with darker pigmented patches of skin in a “mask-like” appearance on the forehead cheeks and upper lip. These patches, often triggered by sun exposure, hormonal changes, and genetic factors, can lead to more persistent hyperpigmentation, making management more complex than for lighter skin tones. Additionally, some treatments offered for melasma can irritate the skin which can cause further unwanted pigmentation in darker skin.

UV light and melasma

UV light from the sun causes sunburn and ageing of the skin. It also increases the risk of future skin cancers and causes pigmentation. It’s the longer UVA waves and possibly even visible light, that penetrate deeper in the skin that are more associated with pigmentation of the skin.

Protecting yourself from sun exposure

UVA rays become stronger in the spring and summer as the earth tilts towards the sun. Holidays to warm climates also lead to higher levels of UV exposure. Sunscreen becomes a crucial ally in the battle against melasma, protecting your skin from harmful UV rays and preventing further pigmentation.  The key here is meticulous sun protection using a high-quality sunscreen that covers both UVB but also the UVA rays, wearing protective clothing, and seeking shade.

Sunscreen must be applied consistently every day and reapplied during the day as it will wear off. Even very short exposure to the sun on one occasion can trigger pigmentation and undo several months of careful skin protection. There are now some fantastic sunscreens that target the longer UVA range (400nm) and the visible light spectrum (tinted products). These products will be very beneficial for darker skin tones at risk of melasma.

Hormonal fluctuations and melasma: Pregnancy, menopause and hormone replacement therapy

It is well recognised that melasma is influenced by hormones. It can be triggered by some hormonal methods of contraception, and it is associated with the hormonal changes seen in pregnancy. With appropriate skin care and sun protection, these changes do improve after pregnancy. 

The impact of the menopause on the skin has yet to be fully appreciated. The perimenopause is marked by fluctuations in oestrogen levels, and this hormonal shift can influence pigmentation. Changing oestrogen levels disrupt the delicate balance that regulates melanin production and distribution in the skin, potentially triggering or worsening melasma.

Hormone replacement therapy (HRT) can also aggravate melasma. Some women may even develop melasma as atypical sites such as the forearms. The menopause also affects other elements of the skin structure, for example the skin barrier, causing the skin to become drier and more sensitive. This can lead to irritation that may make any pigmentation worse.

Challenges when treating melasma in darker skin tones

Individuals with darker skin tones are more prone to post-inflammatory hyperpigmentation, adding a layer of complexity to melasma treatment. Some management approaches like retinoids, hydroquinone, chemical peels, or laser therapy may cause irritation of the skin leading to worsening pigmentation or scarring. The key lies in personalised, gentle treatments that consider the unique characteristics of darker skin.

Tips for managing melasma in darker skin tones

If your skin is sensitive either naturally or because of the menopause, ensure that you are using gentle cleansers moisturisers and other skin products that are appropriate for your skin. Many over the counter products such as retinol can irritate the skin and can increase pigmentation in the skin. Likewise, if you are using cleansers that are too harsh on your skin, this can lead to dry skin that can also pigment.

Incorporate a high-quality UVA and UVB sunscreen into your daily routine and reapply regularly. Keep some in your handbag to use during the day when you are out and about.

Consider gentler topical treatments and regimes in darker skin tones. The retinoids and hydroquinone can cause irritation and pigmentation. Products such as azelaic acid may be better tolerated (though this still can cause some irritation in sensitive skin types). Start all topical treatments gradually e.g. 3-4 times a week and build up slowly to minimise any irritation. If you do notice dry or irritated skin, reduce the use of the product, or stop completely and speak to your health professional.

Dermatologists can help with melasma in all skin types

Navigating melasma whilst taking into consideration sensitive skin and darker skin tones requires personalised guidance from knowledgeable health professionals. Consultant Dermatologists can provide tailored treatment plans, incorporating suitable topical treatments, chemical peels, or laser therapies if appropriate for your skin. Chemical peels and laser treatments in darker skin tones should only be carried out by a dermatologist.

A vascular link to melasma

There is now evidence of a vascular element contributing to the development of melasma. We see larger blood vessels in the skin in those with melasma. Tranexamic acid, a medication in pill form, can help treat this and reduce pigmentation of the skin. Tranexamic acid is not licenced for melasma and cannot be used if there is a strong history of blood clots in your family, but it may be a helpful treatment for some women with melasma especially if the topical treatments are not tolerated. Speak to your dermatologist for advice.

Remember, consulting with a dermatologist ensures that your unique skin characteristics and concerns are considered in the management plan.

Help is out there for those with melasma!

 can present unique challenges for individuals with darker skin tones and the impact of menopause adds another layer to this complex condition. By prioritising sun protection, using gentle skincare routines, and seeking guidance from dermatologists, you can effectively manage melasma and embrace healthy, radiant skin. You're not alone in this journey—consult with professionals who understand the intricacies of melasma and can guide you towards personalised solutions for your unique skin.

Dr Claudia DeGiovanni, Consultant Dermatologist

Find Claudia here and here.

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