What Is Melasma?
Melasma is a chronic skin condition characterised by brown or grey-brown patches, usually on the cheeks, forehead, upper lip, nose, or chin. It is a type of hyperpigmentation caused by overactive melanocytes—cells responsible for producing melanin, the pigment that gives skin its colour. Melasma tends to occur more commonly in women and people with darker skin tones. While it is not dangerous, it can significantly affect self-confidence and emotional well-being.
What Causes Melasma?
Understanding what triggers melasma is key to managing it effectively. Common causes and contributing factors include:
- Sun Exposure: UV rays stimulate melanin production, making sun exposure the number one melasma trigger.
- Hormonal Fluctuations: Pregnancy, birth control pills, and hormone replacement therapy often lead to melasma, sometimes referred to as "the mask of pregnancy."
- Genetic Predisposition: If you have a family history of melasma, you're more likely to develop it.
- Skin Inflammation: Pollution, harsh skincare products, and certain medications can irritate the skin and worsen pigmentation.
- Heat Exposure: Not just sunlight, but exposure to heat (like cooking or saunas) can also trigger melasma.
- Dermal-Epidermal Junction: The health of your DEJ is a large contributor to the formation of melasma.
The Role of the Dermal-Epidermal Junction in Melasma
When the basement membrane becomes damaged, melanocytes and pigment particles can penetrate deeper into the dermis, forming pendulous melanocytes. This dermal pigmentation is far more challenging to treat than superficial epidermal pigmentation.
Why Repairing the Basement Membrane Is Essential
- Prevents Deeper Pigment Migration: A healthy DEJ stops melanocytes and melanin (pigment) from descending into the dermis.
- Reduces Hyperpigmentation: Key proteins like Collagen IV and Laminin-5 — degraded by enzymes called MMP-2 and MMP-9 (often triggered by UV exposure) — are vital for maintaining DEJ integrity.
- Improves Treatment Success: Restoring the basement membrane allows standard melasma treatments to work more effectively.
- Minimises Recurrence: Strengthening the DEJ offers long-term pigment control and reduces relapse rates.
Understanding the Vascular Component of Melasma
Emerging research reveals that increased vascularity plays a key role in the development and persistence of melasma, not just excess melanin. Melasma-affected skin often shows more and larger blood vessels, which contribute to pigmentation in several ways. The overproduction of vascular endothelial growth factor (VEGF) promotes new blood vessel formation and dilation, enhancing the delivery of pigment-stimulating signals to melanocytes. These blood vessels release inflammatory substances like histamine, further triggering melanin production. Additionally, leaky capillaries cause local inflammation, which worsens pigmentation, making vascular involvement a crucial factor in understanding and treating melasma effectively.
How Sun Exposure Worsens Vascular Changes in Melasma
Sun exposure is one of the main triggers of melasma, and it does more than darken the skin. UV rays can increase blood vessel activity in the skin, worsening pigmentation. This happens in a few ways:
- VEGF Production: UV rays increase a protein called VEGF, which causes new blood vessels to form.
- Increased Nitric Oxide: UVB light boosts nitric oxide levels, leading to widened blood vessels and more melanin (pigment) production.
- Skin Barrier Damage: Ongoing UV exposure damages the skin's structure, which can lead to more blood vessel growth and pigmentation.
This is why daily sun protection is essential when treating melasma, especially when increased vascularity is part of the problem.
How Hormones Affect Melasma and Blood Vessel Activity
Hormones play a significant role in melasma, especially regarding changes in blood vessels and increased pigmentation.
- Oestrogen increases blood vessel growth and makes pigment-producing cells (melanocytes) more active.
- Progesterone and luteinising hormone (LH) can also influence the skin's sensitivity to pigmentation, but to a lesser degree.
- Thyroid hormones, especially in thyroid disorders, have been linked to melasma and can affect pigmentation and blood flow in the skin.
These hormone-related changes help explain why melasma is often seen during pregnancy or with hormonal contraceptive use.
How Gut Health Influences Melasma
Emerging research links chronic pigmentation like melasma to gut imbalances, leaky gut syndrome, and inflammation. Poor gut health can increase systemic inflammation, contributing to hormonal imbalances and oxidative stress, which can worsen hyperpigmentation.
Probiotics, prebiotics, anti-inflammatory foods, and eliminating gut disruptors like gluten, dairy, and sugar may help reduce flare-ups and improve skin clarity over time. Working with a functional medicine practitioner to heal the gut can offer long-lasting improvements in skin health.
Lifestyle Factors That Worsen Melasma
Your daily habits majorly affect how your skin responds to treatment. Factors that can trigger or worsen melasma include:
- Unprotected Sun Exposure: Not wearing SPF or hats can undo all your progress.
- Hormonal Contraceptives: Can trigger or aggravate melasma due to synthetic oestrogens.
- Stress: Chronic stress affects hormone levels and triggers inflammation, which can manifest on the skin.
- Poor Sleep and Diet: These affect both gut health and hormone regulation.
Adopting a melasma-friendly lifestyle—including sun avoidance, stress management, anti-inflammatory nutrition, and hormone balance—can significantly support treatment success.
Why Melasma Is So Difficult to Treat
The disruption of melanocyte activity (pigment-producing cells) is at the core of melasma. However, deeper cellular changes, particularly at the dermal-epidermal junction (DEJ) — also known as the basement membrane — play a critical role in melasma's development and recurrence.
The Power of Combination Treatments for Melasma
Melasma is a complex condition that requires time, consistency, and a personalised treatment plan. At Skin Renewal, we don’t simply treat the surface — we focus on the underlying causes, from hormonal imbalances to gut health, inflammation, and environmental triggers. Our doctor-led team designs comprehensive protocols that combine advanced in-clinic technologies, customised skincare, oral supplements, and lifestyle modifications.
This multi-layered approach allows us to target pigmentation on both the surface and deeper skin layers, helping restore healthier, even-toned skin. Every treatment plan is carefully tailored after an in-depth consultation, ensuring that each patient receives safe, effective, and sustainable results that address immediate concerns and long-term skin health. Skin Renewal offers advanced melasma treatments tailored to each skin type and severity level. These include:
- Chemical Peels: Peel treatments target superficial pigmentation and accelerate cell turnover.
- Laser and Light Treatments: Lasers such as Pico Toning, Fractional lasers (Pico Fractional) and IPL (Intense Pulsed Light) can safely address deeper dermal pigmentation.
- Skin Needling: Devices like Dermapen, R.Pen, Secret RF Needling and Enymed Intensif enhance product penetration and stimulate skin regeneration.
- Transdermal Mesotherapy: Delivers pigmentation-reducing actives deep into the skin using FDA-approved Dermo-electroporation technology.
- LED Light Treatments: Photo Dynamic Therapy supports skin healing, reduces inflammation, and improves skin tone.
- Mesobrite™: This is an advanced depigmentation treatment exclusive to Skin Renewal. It is designed to effectively target stubborn pigmentation, such as melasma and post-inflammatory hyperpigmentation.
These treatments are prescribed based on your melasma type—epidermal, dermal, or mixed—and your skin's sensitivity.
Topical Products and Oral Supplements for Melasma
A consistent at-home skincare regimen is essential in managing melasma. While in-clinic treatments provide visible change, at-home care and internal support are essential for maintaining results. Skin Renewal has developed its exclusive range of skincare products to deliver medical-grade ingredients to your skin.
Key Skin Renewal products to look for:
Other Key Ingredients Beneficial to Melasma:
- Niacinamide: Reduces inflammation and pigmentation.
- Retinoids (Retinol or Tretinoin): Encourage skin renewal and prevent pigment buildup.
- Hydroquinone (prescription only): A gold standard for melanin suppression.
- Tranexamic Acid: Found in both topical and oral form, it's a powerful agent for stubborn pigmentation.
Lifestyle Strategies to Support Vascular Stability in Melasma
