Melasma, the "king of spots", is not easy to lighten

Author: Li Menghan, deputy chief physician of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine

Reviewer: Zhang Bingxin, Chief Physician, First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine

What is Melasma?

Melasma is a chronic, acquired facial pigmentation skin disease, clinically manifested as light brown or dark brown patches of varying shades and unclear boundaries symmetrically distributed on the cheeks, forehead and chin. The incidence rate in Asian women of childbearing age is as high as 30%, and it is difficult to cure. Traditional Chinese medicine believes that the occurrence of melasma is closely related to the dysfunction of the liver, spleen and kidney, and calls it "dark spots" and "liver spots". Melasma is known as the "king of spots", prone to recurrence and difficult to cure. The main goal of treatment is to lighten spots and reduce recurrence, rather than completely remove spots.

Figure 1 Copyright image, no permission to reprint

Why does melasma occur?

Genetics, sunlight exposure, and changes in sex hormone levels are the three main causes of chloasma. In addition, sleep disorders, inferior cosmetics, thyroid diseases, etc. can also induce chloasma.

How to treat melasma?

Avoid inducing factors, pay attention to sun protection, use functional skin care products that repair the skin barrier and whitening skin care products, combine clinical staging and classification, and combine systemic and topical medications, chemical peels, lasers and traditional Chinese medicine treatments. Photoelectric therapy is not recommended as a long-term maintenance method. Even in the stable period, it should be gradual to avoid irritating melanocytes, aggravating inflammatory reactions, and damaging the skin barrier.

——Basic treatment

1. Sun protection, sun protection, sun protection: It is important to say it three times. Sun protection is the basis of chloasma treatment and runs through the entire treatment process of chloasma. Whether it is sunny or cloudy, you must pay attention to blocking ultraviolet rays, you can apply sunscreen, or wear a hat and sunglasses.

2. Get enough sleep, have a good attitude, and adjust your work and rest schedule. It is important to ensure adequate sleep and a good attitude, and adjust your lifestyle, including reducing heat contact such as cooking, and avoid using inferior cosmetics that contain excessive mercury and lead content.

3. Whitening skin care products: Avoid using skin care products containing irritating ingredients, and avoid rubbing your face vigorously to prevent damaging the skin barrier. It is recommended to choose whitening skin care products that take into account both efficacy and safety and have been clinically proven under the guidance of a doctor.

——Drug and phototherapy

Drugs include tranexamic acid, glycyrrhizic acid, vitamin C and vitamin E, glutathione, topical anthraquinone and its derivatives, etc. In the stable stage of the disease, it can be combined with fruit acid chemical peeling, photoelectric and other comprehensive treatments. Common chemical peeling agents include fruit acid, salicylic acid, compound acid, etc. Photoelectric therapy mainly includes Q-switched laser, picosecond laser, non-ablative fractional laser, radio frequency and intense pulsed light, etc. Note that photoelectric therapy and chemical peeling therapy must be avoided during the active period.

——Traditional Chinese Medicine Treatment

Traditional Chinese medicine treatment is often based on the principle of soothing the liver, strengthening the spleen and tonifying the kidney, regulating qi, activating blood circulation and removing blood stasis, and treating based on syndrome differentiation. Xiaoyao Pills, Chaihu Shugan Powder, Taohong Siwu Decoction, Shenling Baizhu Powder, Liuwei Dihuang Pills, etc. are commonly used. Traditional Chinese medicine for external use is mostly Bletilla striata, White Aconitum, Bombyx Batryticatus, Pearl, Angelica, Winter Melon Seed, Apricot Kernel, etc. Acupuncture can be used at Xuehai, Sanyinjiao, Zusanli, Quchi, Feishu and other acupoints. Local acupuncture in the stable period also has a certain effect. In addition, methods such as acupoint thread embedding, scraping, and ear acupuncture can also be used.

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In summary, melasma is a difficult-to-treat pigmentation spot, and the condition may even recur during treatment. The "king of spots" is not a false name. Do not easily believe in products and advertisements on the market that can completely cure melasma. Sun protection should be carried out throughout the entire process of melasma treatment, and adequate sleep and a good attitude should be ensured. Western medicine, photoelectric therapy, traditional Chinese medicine, acupuncture and other treatment methods can also be used.