Why melasma keeps coming back

The story of Melasma almost same for every patient. The spots usually fade nicely on a cream or serum. Once they stop applying it, the pigmentation was back even worse and darker than before. You will think this is the failure of cream but in reality, this is exactly how Melasma behaves. Once you understand it, you'll be able to control the pigmentation better.

The short version

• In Melasma, the pigment producing cell (Melanocytes) becomes hyperactive and produces more pigmentation (Melanin).
• Creams, lasers and serums clear pigment that is already made. They do not calm the hyperactive pigment producing cell.
• Hence pigmentation returns once treatment is stopped. This is reason why we should control triggers as well.

What switches the pigment machinery on?

• Sunlight and visible light. Including light through windows, tubelight and screens.
• Heat. Commonly kitchen stove heat and outdoor hot climate.
• Hormones. Pregnancy, thyroid issues, irregular cycles, hormonal pills.
• Inflammation and damage to skin. Using harsh scrubs can make it worse.

This is why Melasma is stubborn in Ahmedabad. We get six to eight months of strong sun and heat where most of us commute is in it.

What can I do to calm it?

• Sunscreen is essential. Use it 20 minutes before stepping out. Reapply if you are out past midday.
• Heat cover. Wear a scarf or thick cotton (or better, UPF rated clothing) while outside. Stand back from the kitchen stove or grill.
• Gentle procedures. Dermatologist approved peels or low-fluence laser toning suited for your skin. Aggressive settings used by unqualified laser operators rebound the pigmentation.
• A check for other causes. Thyroid issues, hormonal fluctuations, vitamin deficiency should be done in stubborn widespread pigmentation.

What to expect?

• First visible change noticed after 1 - 2 months.
• Real difference in 3 - 4 months.

Two things that ruin results

• Stopping sun protection once the skin looks clear.
• Switching creams every few weeks because something stronger was promised online.

The four-product routine that beats a twelve-step one

It is common nowadays to see impressive shelves of dozens of products on one's mirror countertop. Ten bottles and four actives, where three of them do the same job.

The skin gets irritated and breaks out. Almost always, the fix is to minimize the long routine into a simple yet effective one.

The short version

• Skin needs four jobs done: Clean | Hydrate | Protect | Treat
• One product per job is enough.

The four products

• A gentle cleanser
  Twice a day with lukewarm water. If your face feels tight afterwards, the cleanser is too harsh.
• A moisturiser
  Gel-cream for oily skin. A richer cream for dry skin.
• Sunscreen
  Every morning. Prevents tanning, pigmentation, early lines and collagen loss. Reapply if you are out through the day.
• One active for your main concern
  Retinoid for acne, texture and ageing, Vitamin C or niacinamide for dullness, Salicylic acid for comedone and congestion. Pick one, manage one condtition effectively before starting another active.

The order

• Morning: Cleanse → Moisturise → Sunscreen
• Night: Cleanse → Moisturize → Active

How to start an active

• Built up tolerance slowly. Use it twice a week at first. Then increasing frequency as prescribed over 1 - 2 months.
• Give any change eight to twelve weeks before you judge it.

What to leave out

• Daily scrubs and alcohol toners.
• DIY homemade masks.
• Fairness creams that contain steroids. These cause facial damage that is hard and rarely irreversible to treat.