May 23, 2016

One Woman's Struggles With Melasma

Editorial Voice
One Woman's Struggles With Melasma - ZALEA Article Banner

One day, Shaista Iqbal reached for bottle of bleach from her kitchen cupboard. Acting against common sense, she proceeded to apply it directly to her face. “I was so desperate. I thought my skin would peel off and I would look normal again. But the skin was raw and I was in agony for weeks,” she remembers.  
A mother of four from Birmingham Shaista, 44, was suffering from melasma. This common skin condition left her face unusually dark, patchy and discoloured. Facing her now – with her brilliant eyes and even skin – it is difficult to imagine that Shaista’s complexion was ever so bad, and her self-esteem so low, that bleach seemed like the only answer.

The darkening symptoms of melasma (known as chloasma if it occurs during pregnancy) are usually concentrated on the upper cheeks and forehead. It is far more common in women than men, and tends to occur between the ages of 20 and 40. It is caused by the overproduction of melanin, which is triggered by oral contraceptives, HRT and pregnancy, as estrogen increases the skin’s sensitivity to ultraviolet light.

According to Dr Neil Walker, a consultant dermatologist at the Churchill Hospital, Oxford:  “Melasma is exacerbated by ultraviolet light exposure, not only from natural sunlight but also by UVA emitted from artificial light sources.” Other catalysts are cosmetics and scented toiletries, which can cause phototoxic reactions and hypothyroidism.

Four years ago, Shaista was on the contraceptive pill when she began noticing small dark patches beneath her eyes. The condition worsened when she became pregnant with her fourth child in 2010. Dr David Eccleston of MediZen, a clinic in Sutton Coldfield explains how melasma is “…more common in people who tan well or have naturally brown skin.”

While neither harmful nor painful, the consequences can be difficult to face. “I couldn’t look in the mirror. I got to the point where I wouldn’t leave the house and I was on anti-depressants,” reflects Shaista.

Treatments such as acid peels, skin-lightening creams, lasers and tranexamic acid pills (used to reduce heavy menstrual bleeding) are available, but with no guarantees.

Once Shaista came off birth control, she tried every treatment on the market to no avail. Finally, last year she was prescribed a course of creams from the Obagi Nu-Derm range after consulting the Harley Medical Group in London. Success! “The creams contain hydroquinone and tretinoin [a form of vitamin A] and, by penetrating the deep dermal layer, they can make a difference in four weeks,” says Dr Nicky Naylor of the London group. “I want everybody who’s got this condition to know there is a way out,” reflects Shaista.

It is possible for melasma to naturally fade once hormone levels balance out, but there are often permanent signs unless treated. Wearing sunblock year-round is highly advised to anyone who with marked pigmentation, as Shaista now does.

This Zalea Original piece was edited and approved by the Zalea Editorial Team.


Editorial Voice
Christopher B. Zachary, MD for the Editorial Voice - ZALEA Christopher B. Zachary, MD

This article, originally published in the UK Telegraph newspaper, reviews one patient’s story concerning her melasma … stating that in her opinion the Obagi Nu-Derm range of products is the answer for melasma. It should be emphasized that the combination of hydroquinone, tretinoin and steroids was originally suggested by both Arndt and Kligman decades ago, and remains first line treatment for patients with melasma. In the USA, appropriately named Tri-Luma by Galderma™ is the generally accepted premier formulation for this indication and the only one that is FDA approved. For those patients who fail topical treatments, devices do indeed hold potential for improvement and include the fractionated non-ablative lasers, the Q-switched lasers, and some chemical peels amongst others.

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