Tuesday, 29 October 2013

Melasma – Types and Treatment

Understanding Melasma

Melasma is a skin problem that makes the facial skin look symmetrically blotchy. It is a brownish pigmentation that appears on the face and is also known as chloasma or green skin. This however is only a cosmetic problem and does not have any other deep medical issues. The melanocytes or the pigment cells in the skin are overproducing melanin and hence the condition.

Occurrence of Melasma

Melasma is a common, acquired, progressive and non-scaling hyper pigmentation disorder that generally occurs in the region of the face especially on the cheeks, central face forehead, upper lips, nose, bridge of the nose, and chin, more frequently seen around the eyes. In short it occurs in areas where the skin is exposed to the sun. Melasma appears to resemble age spots but covers larger areas of darkened skin. It also can appear on other parts of the body that get lots of sun, such as the hind side of the forearms and the back of the neck.

Distribution Pattern

Melasma is typically distributed in any one of these patterns:
  1. 63% occurrence is around the nose and chin area.
  2. 21% over the cheeks and nose areas of the face.
  3. 16% known to occur around the lower jaw.
  4. Occurs very commonly in people who have darker skin or light brown skin where intense solar ultraviolet radiation exists. Thus people from East and south East Asian and Hispanic regions are prone to develop Melasma. It is more common in women than in men (9:1) and is rare before puberty, occurring most commonly in women of reproductive age.
  5. It is also known to affect 80% of pregnant women, and hence often referred to as the “Mask of Pregnancy”.  

Types of Melasma

Melasma can be one of three types:
  • Epidermal or on the outermost layers of cells on the skin
  • Dermal. Melasma occurs in the layer that lies between the epidermis and the subcutaneous layers of the skin
  • Mixed refers to presence of Melasma in the epidermis as well as the dermis.

Color and Appearance

  • Melasma occurring in the epidermis is light brown in color and this discoloration appears to be darker when viewed under a wood lamp.
  • Dermal Melasma is grayish in appearance and does not appear darker when viewed under a wood lamp.
  • The mixed type of Melasma is dark brown and when examined under a wood lamp, may either appear to be darker or there may be no change.

  1. Harmful and overexposure to the Sun
  2. Pregnancy - fades a few months after delivery
  3. Hormone treatments including oral contraceptive pills containing estrogen and or progesterone, hormone replacement, intrauterine devices and implants.
  4. Scented or deodorant soaps, toiletries and cosmetics which can provoke Melasma which can then persist long-term.
  5. Phototoxic reactions to certain medications.
  6. Melasma has also been associated with hyperthyroidism. 

Treating Melasma - Results and Precautions

It is important to first distinguish the type of Melasma present as:

  1. Epidermis Melasma which occurs superficially or on the surface of the epidermis is the most easily treatable types of Melasma.
  2. The Dermal Melasma is more deep rooted and therefore does not respond to bleaching agents. Dermal Melasma has no defined borders unlike Melasma present on the Epidermis where the borders are clearly defined. Dermal Melasma does not respond too well to treatment.
  3. The mixed type of Melasma generally improves with treatment.
  4. Discontinuation of any hormonal contraception.
  5. Year round protection from the sun
The ideal treatment for a quick result is just to destroy the pigment, while leaving the cells alone. Laser Therapy is by far the best.

Tuesday, 15 October 2013

Laser Hair Removal over a Tattoo

Laser Treatments

Laser pulse lights are used to remove tattoos as well as unwanted hair. However, it is essential to note that these treatments use two different lasers. The intensity of the laser beam to remove tattoos is high but the laser used to remove unwanted hair is of a much higher intensity. So then what effect will this have if the laser therapy were to be used to remove hair that has grown over a tattoo and is distorting or hiding the beautiful artwork on the skin?

Dangers and Effects of Removing Hair Growth over a Tattoo 

  1. Despite the progress in laser treatments and removal of hair in general, it is still not advisable to remove hair that is growing over a tattoo, using the laser therapy.
  2. The laser light that beams down is drawn to the pigments in the tattoo, regardless of the color of the ink. Since the tattoo ink is darker than the color of the skin, the ink will easily absorb the laser beams.
  3. When inexperienced technicians operate the laser and there is a misadventure, this will cause burning, fading, blackening and distortion of the tattoo / tattoos.
  4. Since removing hair requires a much stronger laser intensity, and when the laser inadvertently touches the tattoo, it can remove or disfigure the tattoo and it can even burn the skin pretty much severely.
  5. Having a permanently damaged tattoo is not a pretty sight.
  6. If you have a colored tattoo, there is a possibility that the laser will turn the tattoo completely black.
  7. Most often due to carelessness or inadvertent “slipping” of the laser beam over a tattoo, painful blisters form, filled with pus and this leads to infection, almost immediately, which means a visit to the Emergency Room.
  8. After healing of the blisters, the inevitable scaring will be present.
  9. Depending on your body's healing capacity, it may take years before the scars flatten out enough, before you could think of getting a fresh tattoo to replace the disfigured one.
  10. Most artists will not tattoo over fresh scars.
  11. If you have moles on your skin where the hair has to be removed, the laser treatment will produce the same effect that it will on a tattoo.

Precautions to be taken

  1. Ensure that the doctor or esthetician who will be performing the hair removal over your tattoo has had considerable experience and is certified.
  2. If you have sensitive skin, do follow the procedures that you would follow to remove hair from your skin, such as, not be exposed to the sun (getting a sun tan), not shaving or waxing to remove hair, for a period of at least 2 weeks prior to your laser hair removal treatment.
  3. If you are sensitive to pain, take over the counter relief (after having discussed with your doctor or esthetician) like Tylenol or Advil.
  4. Numbing cream can also be applied to the treatment area, if so desired.


  1. Prior to the procedure you will need to inform your doctor or esthetician if you have any tattoo on your skin or close to the area where you desire to remove hair.
  2. The esthetician will then mark off the areas where the tattoos are, or cover it up to protect and to ensure that the laser goes nowhere near the tattoo.

Possible Side Effects

  1. Itching or redness in the treated area; the redness lasting only for 3 days.
  2. Tingling or numbness.
  3. Possible swelling around the follicle for 3 days.
  4. In very rare cases there may be a temporary pigment change.