The term melasma refers to disorders in skin pigmentation. They can appear all over the body, but are more prominent and common in sun-exposed areas such as the face and hands. In this broad category, we can include solar lentigines, or less kindly referred to in the past as age spots, melasma, also known as chloasma, where hyperpigmentation is deeper in the skin, post-inflammatory hyperpigmentation, which is a disturbance of pigmentation after inflammation, and freckles, which is a term used by patients and usually refers to melasma. Proper identification of the type of lesion by a specialized dermatologist is essential for treatment, as one type of pigmentation disorder is Malignant Melanoma, which resembles solar lentigines. This type of skin cancer requires a different treatment, which is surgical removal with specific margins.
For the treatment of these pigmentation disorders, we use conservative therapies both in the form of topical agents and systemic medications. Crucial is the contribution of peels with specially selected acids, both in terms of type and concentration, as well as the duration of their application. Finally, a revolution in the treatment of these pigmentation disorders has been brought about by laser applications with wavelengths targeting melanin as a chromophore for selective absorption of the energy emitted by the machine. This way, we can 'heat up' some lesions simply by heating the surrounding skin without destroying it, as would happen with a simple carbon dioxide laser. In recent years, the evolution of these machines with the ability to have pulses in a very short time has led to Q-switch laser technology, which, due to its very short pulse, does not heat the surrounding skin and is essentially painless in its applications for pigmentation issues. In all cases, the use of sunscreen is essential for prevention, as well as for treatment and prevention of recurrence.
Solar Lentigines and Their Treatment
Solar lentigines are very common benign lesions that appear after years of sun exposure and with age. They are essentially superficial lesions that appear more frequently on the face, on the dorsal surface of the hands, and on the décolleté. In this case, we can effectively eliminate these lesions in a single session using Q-switched Laser at 532nm, without pain and with minimal recovery time. After the session, which does not require any anesthesia cream, the lesions darken, thus appearing more prominent for 7-14 days depending on the body area. Recovery is shorter on the face and longer on the hands. Eventually, they fade away like 'dirt' with mild peeling.
If the extent of the pigmentation is large and we do not want to target specific spots, we can undergo IPL (intense pulsed light) photorejuvenation therapy. In this case, we choose the appropriate head emitting at different wavelengths depending on the type of lesion and skin color. The application may cause some discomfort, and anesthetic cream reduces the sensation. Again, after the application, there will be a temporary worsening of the appearance for 10-14 days with darkening of the lesions, which will appear slightly darker. After this therapy, the skin is more youthful and fresh with fewer spots and a more uniform complexion.
When alongside the spots, we have wrinkles and other signs of aging that we want to address in a single session, we can use peeling or CO2 laser. With the application of acids, we achieve controlled exfoliation of the skin surface, removing both these pigments and rejuvenating the skin. By applying carbon dioxide laser, we achieve ablation of superficial tissues and thermal activation of deeper skin for collagen production and regeneration. In both cases, the skin we regenerate is healthier and thicker as a result of better nourishment.
Melasma and Its Treatment
Melasma or chloasma is a much more challenging condition where pigmentation is located in the deeper layers of the skin. Additionally, there is often endocrine involvement in the problem. For this reason, melasma appears more frequently after contraception or pregnancy (mask of pregnancy) or in combination with thyroid disorders. At the same time, we also check iron levels, folic acid, and Β12.
This condition always has the possibility of recurrence, and for this reason, the correct use of sunscreen is crucial. Also, very aggressive treatments with peeling and laser can lead to rebound and worsening of the condition. For this reason, in our clinic, we prefer the two most established treatment methods, which have clear results without the risk of exacerbation. These include the use of a specially formulated cream with gradually increasing concentration of the active substance and the intake of an off-label drug orally. This means that this drug was designed for another purpose and was later found to help with melasma. Although the drug is safe and often given, it is necessary to take a medical history to select the patient, and it should be explained that treatment is required for several months. The active substance of the drug can also be used in the form of mesotherapy, i.e., injection into the skin, both to expedite the results and in cases where oral administration is not chosen. It is also used in peels and creams, although the extent of its effectiveness with these forms remains to be proven.
In all cases, the correct use of sunscreen with high protection is necessary after our treatments.