The Miseries of melasma

I have a dark patch that appeared on my cheek last year. I went to see a dermatologist who treated it with topical therapy and there was an improvement.
But now, after coming back from a summer vacation, the dark patch has started to comeback. I can’t seem to control it.
Why can’t I get rid of it?

The dark patch you describe sounds like melasma. Melasma is a major frustration among Thai women. The main causes are sunlight, heat and hormones Women who have family members who suffer melasma are at increased risk of developing the condition. With Thai women are exposed to the sun for several months of the year, melasma is challenging to control. As soon as the skin stimulated by natural sunlight, recurrences of melasma can occur.
The mainstay of treatment remains lightening topical cream. The best known is Hydroquinone, which blocks the production of excess pigment in the skin, so less melanin is made. But hydroquinone needs to be prescribed by a dermatologist.
There are also various compounds like soy, arbutin, kojic acid and niacinamide. Generally, they are not as strong as hydroquinone. If you have a mild, superficial melasma, topical cream might work and keep your melasma lighter. But if it is severe or persistent, using only lightening topical cream is seldom effective. A combination of lightening cream with other treatments such as peeling and laser treatment may be necessary and will certainly be much more effective.
A number of studies have shown that non-ablative lasers can destroy the pigment in the deeper layers of skin without damaging the upper layer. This results in decreasing the skin discoloration and can keep persistent melasma at bay, leading to a lighter and brighter skin.
However, you will not have any success in treating melasma if you don’t stay out of the sun at the height at the day or block the sunlight. Daily application of sunscreen is recommended and your sunscreen must block UVA as well as UVB.

Thanisorn Thamlikitkul MD is a member of the American Society of Cosmetic Dermatology and Aesthetic Surgery and certified in dermatological laser surgery. Send your questions for her to [email protected].