This is Dr. Robert McGrath of Juventix Regenerative Medical.
I would like to discuss Melasma.
Melasma is a common skin disorder exclusively on sun exposed areas. The primary site is the face but it can also appear on the neck and forearms. Melasma is harmless physically but can have a significant emotional impact. It is characterized by brown or blue-grey patches mostly on the cheeks, nose, chin and forehead.
Melasma is very common. It has been called “the mask of pregnancy” because 15 to 50% of pregnant women get this condition. Up to 33% of the female population may get melasma during their reproductive years. However, it is not only a female dermatologic condition as 10% of the cases are male.
Fair skinned people are less likely to get melasma as it is commonly seen in darker skin population or people who tan easily.
Melasma can typically darken and lighten and is usually worse in the summer when the skin is exposed to strong sunlight.
What is it?
Melasma is not a cancer nor a pre-cancerous lesion.
The epidermis contains cells called melanocytes. These cells produce melanin in response to light, heat, ultra-violet radiation and hormonal stimulation. Melasma is an over production of melanin in the exposed areas usually of the face. It is usually bilateral and not raised.
Types of Melasma
There are three types of melasma and they are classified by the depth of the pigment in the skin. This classification can be made by a skin biopsy or commonly by a “Woods Light”. This is an ultra-violet lamp.’
A. Epidermal-Dark brown in color, well defined border and easily seen under Woods Light
B. Dermal-Light brown to blue in color, poorly defined borders and appears no different under Woods Light
C. Mixed-Most common type, brown and blue in color, mixed appearance under Woods Light
What Causes Melasma
A. Exposure to sun, heat or ultra violet radiation
A. Birth control medicines
B. Estrogen/Diethylstilbestrol (Synthetic Estrogen) used in the treatment of prostate cancer
C. Tanning Beds
D. Skin care products/ soaps
E. Genetics-33-50% of cases have a family member who had melasma
F. LED Screens- Tv, Laptops, Cell Phones
G. Thyroid Disease- Very Common and all patients should have thyroid evaluation
H. Medicines- Can directly cause it such as seizure meds or indirectly make you more light sensitive such as diuretics, NSAIDS, antipsychotics and retinoids
Melasma is hard to treat and it can disappear and relapse on its own or stay active for years. There are many medicines and alternative treatments that have been used for this condition. However, two things are mandatory: sun avoidance is mandatory with use of sunscreen at least a SPF of 30-50 and all hormones must be stopped.
Topicals for melasma treatment
A. Azelaic Acid- class of medicines are the dicarboxylic acid type
C. Hydroquinone-skin lightening agent
D. Methimazole- med used for over- active thyroid
E. Cysteamine- L-cysteine inhibits melanin synthesis
F. Tretinoin- synthetic Vit A , in the class of retinoids
G. Kojic Acid- made from fungi in fermentation and contains a antityrosinase agent inhibits melanin
H. Tranexamic Acid- actually is an antifibrinolytic agent that increases clotting but its anti-plasmin activity blocks production of melanin
All these medicines basically block the production of melanin which makes skin dark or lighten the skin
If medicines do not help procedures may be entertained such as laser ablation, chemical peels or dermabrasion. These could have potential serious side effects.
However recent studies have shown Platelet- Rich-Plasma to be an effective treatment for Melasma
Platelet-Rich-Plasma (PRP) is a concentrated component of whole blood that is processed by centrifugation to remove RBC and most of the WBC. It contains the growth factors needed in tissue repair.
It has a variety of applications and the benefits are well documented in the medical literature.
A recent study was documented in the literature about Melasma and treatment with Platelet-Rich-Plasma
Journal of Clinical and Aesthetic Dermatology 2021;14(8):44-48
“Therapeutic Effect of Microneedling with Platelet-Rich-Plasma vs. Microneedling with Tranexamic Acid for Melasma”
Comparison was made between 2 treatment groups. Age, duration of melasma and number of treatments were matched. Other factors were also matched so there were no statistically significant differences between the groups.
The results showed microneedling with PRP was superior than TXA which is one of the most common treatment presently. “Platelet-Rich-Plasma offered better outcomes than TXA in melasma.
Platelet-Rich-Plasma is only limited by the process in which the PRP is concentrated.
Juventix Regenerative Medical Platelet Rich Plasma Kits have been scientifically proven to provide reproducible amounts of product. Juventix has received FDA approval. Not all kits are the same!
Melasma can be a frustrating problem to treat and more frustrating for the patient.
The chronicity and risk of relapse can be high in some cases.
Treatments can be expensive and can have side effects.
Platelet-Rich-Plasma has no side effects or allergic reactions.
In Melasma, Platelet-Rich-Plasma appears to be the best choice for acute cases and chronic maintenance therapy.
Remember, Not all kits are the same.
Dr. Robert McGrath