Dyschromia or Sun Blotches or Chloasma or Melasma ((in medical terminology) are all the same situation.
Irregular flat spots or marks in colour that varies from light to dark brown are the characteristics of melasma.
It usually appears on body areas that are often exposed to the sun (e.g. face, cleavage, hands).
They are created mainly due to the exposure to ultraviolet radiation.
Postinflammatory hyperpigmentation is a different diagnosis and it is usually a combination of a skin inflammation (e.g. skin injury, mechanical or chemical burn etc.) and the exposure to ultraviolet radiation.
General information on skin colour
People’s skin colour varies and in fact it depends on melanophores and melanin. Melanin composition is a complicated process and has to do with the activity of different enzymes and mainly of tyrosinase.
There are various skin colour disorders that may appear as hyperpigmentation (spots with darker colour on certain skin areas) or hypopigmentation (spots with lighter skin colour).
In addition, depending on the age when they appear, pigmentation disorders are:
• Congenital or
Depending on their extent, they are:
• Localised or
Depending on pigment localisation, they are:
• Epidermic (the colour of the spots varies from light to dark brown and the damage is located histologically on the main skin layer).
• Chorionic (the colour of the hyperpigmentations is grey-blue).
• Mixed (melanin is located on both the skin and the corium).
At Nefer, we handle peristatic, localised hyperpigmentation and this is what we will describe in detail in the following paragraphs.
How is melasma – hyperpigmentation created?
Various factors are responsible for the manifestation of melasma and there is no thorough understanding of its aetiology.
With regard to melasma damages, there is an increase in the number of melanophores from the corium towards the upper skin layers.
Melanophores are located at the corium margin and when they become “stimulated”, they produce melanin. In certain cases, such as these mentioned below, melanophores produce more melanin. Imagine melanophores as a tree that is upside down on the skin with its roots towards the skin surface. The whole process of stimulating the melanophores begins from the corium and it gradually appears on the keratin layer. It may take years of recurrent and improvident exposure to the sun and mainly to UV radiation before hyperpigmentations become apparent. In addition, when these finally manifest themselves and you decide to tackle the problem, the aim is not only to stop seeing them by simply removing a few skin layers (usually by chemical or mechanical peelings) but we have to act on the root of the problem where melanin production begins, i.e. we have to stop the activity of tyrosinase which stimulates the melanophore in order to produce melanin.
The factors responsible for the manifestation of melasma – hyperpigmentation are the following:
• The main releasing factor is UV radiation exposure (sun and solarium). Melasma exacerbates or manifests for the first time during the summer months and from the very beginning and if no treatment is followed, then it is certainly going to get worse.
• Hereditary (more often to darker phototypes according to Fitzpatrick III – IV, i.e. to darker skins).
• Hormonal (endocrine disorders, pregnancy, use of contraceptives).
• Phototoxic drugs.
• Following deep peelings, skin injuries, burns and especially when UV radiation exposure follows after the above
• Suspension of tyrosinase activity. This is an enzyme that stimulates the melanophore to produce melanin.
• Removal of the extra melanin.
• Decomposition of melanin particles.
• Corium reinforcement – fattening.
• Covering make-up for psychological reasons.
Melasma is one of the greatest challenges in aesthetics with regard to its treatment, because it tends to regress.
The sufferer must understand the mechanism of their creation thoroughly, because it is very important that the instructions about daily skin care and the necessary use of sunblock are followed, as well as the regular visit every year to the salon for a series of repeating sessions so that the existing pigmentations become and remain lighter and new ones are prevented from forming. Usually the person who has hyperpigmentations carries the greatest responsibility for their manifestation and for this reason we insist that they follow the given instructions faithfully.
At this point we have to clarify that in order for a pigmentation to appear on the skin surface (keratin layer), it means that the problem has started a year or several years before. This is because the negative activity of the sun has a multiplier effect (not even a cumulative one) and once “written” it cannot be “erased”. So, apart from the treatment of melasma, it is also important for us to become aware of its prevention (this begins from a young age when we are first exposed to the sun).
Avoidance of UV radiation exposure (natural – sun or artificial – solarium), especially during the hours of intense sunlight.
• Use of a sunblock throughout the year (and more specifically right) use of the appropriate sunblock as recommended by your beautician).
• Use of hat and sunglasses.
• Use of whitening and gentle exfoliating products at home.
Our beliefs on chemical peeling and micro dermabration
At Nefer, we do not agree on intense chemical peeling and we disapprove of the use of micro dermabration or herbal peeling These are methods that have been used so far with impressive results in the beginning. Initially, “dirt” was removed from the outer layers but as the peeling moved deeper (towards the corium) and the skin looked redder following treatment, then this meant that an inflammation had been created on the skin which largely lead to a post-inflammatory hyperpigmentation at a later stage. In addition, very deep peelings that reach the corium (with naked eye one can see very bright red skin that stings and shines) destroy the corium.
• A gentle and controlled chemical peeling so that the pigmentation is removed from the skin externally, with simultaneous use of anti-inflammatory ingredients and anti-oxidants
• The reinforcement of the corium thickness.
The above is achieved by gentle stimulation of fibroblasts which produce collagen and elastin, such No-needle Mesotherapy. Microneedling (derma roller), Natural lifting – Metatherapy.
In addition, the use of skin cosmetics with gradual increase in the dose of vitamin A reinforces the corium thickness and acts in a photo-protective way (ENVIRON products).
• Use of whitening agents.
• Use of tyrosinase inhibitors.