What is chloasma?

 

Chloasma is a term used to describe a pattern of pigmentation of the face affecting the cheeks and sometimes the nose, forehead and upper lips.  It is also called Melasma.

 

 

What is the cause of Chloasma?

 

The cause of Chloasma is unknown. However, there are some known trigger factors.

 

• Pregnancy

• Oral contraceptives

• Hysterectomy

• Ligation

• Sunlight

 

It is thought that the hormone Oestrogen is responsible for the production of Chloasma.

No matter what the trigger factor is, one central underlying factor is the exposure to sunlight.

 

 

What treatments are available for Chloasma?

 

Chloasma is at best difficult to treat. In the past several remedies with various success have been tried. The include:

 

• Hydroquinone

• Skinoren

• Retin A

• Kojic Acid

• Thiolin

 

These have all worked to a certain degree but not consistently enough to be regarded at the treatments of choice.

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Additional procedures that are beneficial in the treatment of chloasma include:

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• Microdermabrasion

• Chemical peeling

• Microneedling

 

 

How is hydroquinone used?

 

If hydroquinone is prescribed, it should be used for a maximum of three months.  Thereafter, its use should be discontinued or reduced.   Prolonged use of hydroquinone could cause a peculiar pattern of darkening of the skin called Ochronosis.  The higher the concentration of hydroquinone and the longer its use, the greater is the likelihood of development of ochronosis.  

 

 

Sunblock should always be used with hydroquinone containing products.

 

Apply the cream to the affected areas at night only. If you see a response within three months, you will be allowed to continue cautious use of the product on an intermittent basis. However, if no response is seen within three months, further use should be discontinued. It is advisable to use the cream  with its own Cleanser and Sunblock, available from your dermatologist.   The use of the Hydroquinone, Cleanser and Sunblock constitutes the home care range.

 

 

New treatment for Chloasma

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1. A pigment lightening cream called Thiospot is now availabke from the Synchroline in Italy.  This is a non hydroquinone product and is applied twice a day.  Its main ingredients are acetyl glucosamine, phynyl ethyl resorcinol and ethyl linoleate.  It is used as a safer substitute for hydroquinone and there is no limit to the amount of time it can be applied.

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2. Thiospot may be combined with Chemical Peels, Microdermabrasion and Microneedling for the treatment Chloama.

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How is microdermabrasion performed?

 

Microdermabrasion is a novel treatment for the lightening of Chloasma.  It utilises Aluminium Oxide Crystals (Corundum) which is the second hardest known substance after diamond.  This is applied under pressure to the skin.  The treatment is combined with lightening agents such as hydroquinone and Kojic acid.  One treatment a month is recommended for a period of 8 months.

 

How long does it take to see a result?

 

Usually, anything from three to six months, depending on the number of sessions performed.

 

Are there any side effects?

 

Some discomfort  may be experienced during the procedure.  However, it is usually well tolerated.

 

 

New treatment for chloasma

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In a study published in the Journal of the American Academy of Dermatology in August 2016, involving more than 500 patients, oral tranexamic acid (CycloKapron) was shown to reduce pigmentation of chloasma in 89% of subjects.

The medication is contraindicated in those with a history of deep vein thrombosis (DVT), stroke and cardiac disease.

The dose is 250mg twice a day.

Improvement is seen in two months.

Failure to respond in three months should result in discontuation of the medication.

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Procedures for chloasma

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1. Microdermabrasion

2. Chemical Peeling

3. Microneedling

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