• melasma

Update on melasma, which new treatments are available?

I’ll just get straight to the point, melasma (also known as pregnancy mask) is no more than a very frustrating pigment condition. That is because those bizarre, dark patches on the face can be difficult to get rid of. If you, yourself, suffer from it, or know someone who does, then you’ll understand exactly what I mean. Up until now most treatments for melasma have been focused on bleaching the patches. Sometimes that is only partially successful, but fortunately research never stops. There are already other interesting possibilities, and still to come, for treating melasma. I would like to share these with you.

Antihistamine for melasma, can an allergy tablet help?

The role of mast cells
Histamine and antihistamine may cause hay fever or other allergic reactions to spring to mind. And that make sense because histamine is a substance which is released from the so-called mast cells when you come into contact with an allergen or foreign substance. That can be via your skin, but also via your lungs and stomach. These mast cells reside there as well as in other areas. The histamine which is released can then cause an allergic reaction.
So what’s new? It now appears that histamine and mast cells also play an important part in the presence of melasma.

Collagen break down and pigment that sinks in
People with melisma are seen to have extra mast cells in the dermis. And those mast cells do many things which, when combined, affect the forming of pigment. Other substances in mast cells cause an increase in blood vessels which are also seen with the condition. And there are even more substances which break down a certain type of collagen. It concerns collagen type 4 which is found in the basal membrane of the skin. That is the layer between the epidermis and the dermis underneath. A consequence of this layer being broken down is that the pigment sinks from the outermost skin layer to the deeper layer. And that is exactly why melasma is so difficult to treat, the pigment is quite deep.

Can an antihistamine tablet work?
New studies are looking into the possibility of fending off those mast cells, so that the pigment doesn’t reach the deeper layer, but remains on the surface, where we can treat it more easily.
Perhaps a type of antihistamine medicine is the answer. Such a medicine, that you can, for example, also take for an allergy counteracts the action of the histamine from the mast cells. Various studies have demonstrated that the forming of pigment is halted through this. Research is being carried out now into whether, and in which way, a daily dose of hay fever tablet can improve melasma complaints. And then of course without this disrupting other important processes in your body.

Tranexamic acid for melasma, what are you choosing?

Another new medication for treating melasma is tranexamic acid. Well it isn’t exactly new, it is a medicine which promotes blood clotting. The medicine is mainly used in preventing bleeding or stopping it in people with coagulation disorders (e.g. if they need to have an operation) or excessive blood loss.

You may be wondering what the connection is with melasma. How exactly can this medicine work on pigmentation spots? It simply comes down to the fact that tranexamic acid counteracts the production of pigment by halting a specific enzyme. Alongside this, the substance appears to cause a reduction in the blood vessels, which are also part of melasma, and the number of mast cells.

In the last few years many studies have been carried out into the effect and the best form of application of tranexamic acid for melasma; in a cream you can apply onto the skin, as an injection or as a tablet. It seems that oral application of a medicine with tranexamic acid is the most effective. And I know that there are already various clinics that prescribe this.
It is good to know, though, that the dose used for melasma is different from the dose used for promoting blood clotting. There are also reasons for discouraging tranexamic acid for some people. So always consult a doctor!

Kind regards,


Research Physician Cosmetic Dermatology

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