Eat well, rest, and try a few supplements – Since melasma may also be the result of hormonal imbalances, you may improve matters by giving yourself some much-needed TLC. Make sure you’re staying hydrated, eating a diet with plenty of fresh fruits and vegetables, and getting enough sleep each night.
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Contents
What can I use for melasma while pregnant?
Melasma During Pregnancy – Melasma, both during and after pregnancy is related to a woman’s estrogen levels. Estrogen coupled with blood vessel growth, sun exposure, genetics, and hormones deposit pigment in the skin. The best way to treat melasma is with a bleaching regimen such as hydroquinone.
- Hydroquinone at 2-4% works miracles for women with a pregnancy mask,” Dr.
- Zenovia shares.
- Hydroquinone does not get absorbed systemically”.
- Aside from treatment, taking preventative measures is imperative for melasma! When the skin is exposed to the sun, our melanocytes (the cells which produce the brown pigment called melanin) proliferate leading to the darkening of the skin.
In patients who are prone to melasma or have preexisting melasma, sun exposure stimulates melanocyte activity and can darken preexisting spots and create new ones. Dr. Zenovia, therefore, recommends wearing hats and covering your face from direct sun exposure when outdoors.
- A physical sunscreen should be applied daily! A physical blocker has broad-spectrum coverage against harmful UV rays which trigger melanocyte overproduction. Dr.
- Zenovia’s Vitamin C Brightening Moisturizer SPF 30 provides transparent nano-zinc oxide 360-degree mineral protection and contains clinical grade Vitamin C-Ester to visibly help minimize the appearance of dark spots, discoloration, fine lines, and wrinkles,
Dr. Zenovia prefers a physical sunscreen for melasma because it will block more visible light and UV radiation from penetrating the skin compared to chemical sunscreens.
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Does pregnancy melasma go away?
Treatment – Most people with melasma do not need treatment. Melasma may fade away slowly if you stop taking birth control pills or hormone replacement therapy. If melasma appeared while you were pregnant, it may go away a few months after you have the baby.
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Which food avoid in melasma?
3. What food options to eat to treat melasma and freckles? – Eat fresh food Snacks, processed foods, factory-made foods, artificial sweeteners, flavor enhancers, food colorings and chemical additives that are not thought to be in the recipe natural diet.
- Meanwhile, eating fresh, natural, nutritious foods is the best way to get rid of melasma.
- Eating fresh food means eating fruits, vegetables, whole grains, legumes, nuts, meat, fish, eggs, herbs, spices,.
- Food purchased needs to be fresh, requires self-processing, using quality ingredients.
- Avoiding inflammatory foods means avoiding junk food, fast food, processed foods, beverages, and canned ingredients by anything that comes out of bags, cans, boxes, jars, cans, or Bottles can all be processed.
If the food is made from a factory, all sorts of chemicals are added to enhance the flavor or preserve the food that should not be eaten. Avoid inflammatory drinks Not only do processed foods cause inflammation, stimulate skin pigmentation and provide the body with very little nutrition, but also many other such drinks.
Accordingly, in addition to wondering what to eat to get rid of melasma or what to eat to get rid of freckles, if you want to really heal from deep within the body and the skin, you should not drink soda, packaged juice, rose water. energy, sugary tea and also avoid drinking alcohol and coffee. None of these drinks are beneficial for the skin.
Meanwhile, if you want to drink for your health, drink water or drink simple homemade herbal tea or fresh vegetable juice. Stop eating allergenic foods When you eat a food that can be allergenic or difficult to digest, your body automatically triggers inflammation, which can also contribute to hyperpigmentation.
- So, when you want to eat something to treat melasma and freckles, eliminate suspected allergenic foods such as eggs, milk and dairy products, soy and soy products, wheat gluten, marine fish and shellfish, peanuts.
- Reduce carbs For many people, melasma and freckles are hormonal triggers.
- Too many carbs in the diet can cause hormone imbalances and lead to hyperpigmentation.
If melasma occurs during pregnancy, lactation, oral contraceptives, hormone replacement therapy, or worsens at different times of the menstrual cycle, actively monitor Controlling carbohydrates in the diet may be helpful in treating melasma and freckles.
Here are some examples of processed foods that are high in carbs: Sugar and syrup, flour, baked goods (bread, cakes, crackers, bagels, muffins, cookies, etc.), pasta and noodles, chips and crisps, candy and desserts, cereals, soda or alcohol, fruit drinks, sweetened beverages (energy drinks, sweetened teas, beverages) sweet coffee, etc.).
However, there are still fresh sources of high-carb foods to consider cutting back: Sweet fruits (mango, papaya, bananas, grapes, pineapple, etc.), legumes (chickpeas, lentils), black beans, pinto beans, etc.), starchy vegetables (potatoes, radishes, carrots, pumpkins, squash, sweet potatoes, etc.). Để giám nám và tàn nhang nên tránh ăn thực phẩm giàu carbs Antioxidant Supplement Along with eliminating all processed foods and junk foods from the diet while reducing carbohydrate intake; Another important thing in what to eat to treat melasma and freckles is to make sure to consume the right amount of antioxidants daily.
- Antioxidants help reduce inflammation, boost cell repair, and may protect skin cells from free radical damage.
- In this day and age, when constantly exposed to pollution and strong UV rays, the skin needs more protection from within.
- At this point, antioxidants are an important key from a natural diet that can protect the skin from the inside out.
Antioxidants should be in your food: Vitamins C, E, A, resveratrol, flavonoids, beta-carotene, lycopene, lutein and selenium. Accordingly, examples of foods rich in antioxidants are as follows: Berries (blueberries, cranberries, blackberries, raspberries, pomegranates, dragon fruit, kiwi,.) Beans (beans) leeks, black beans, pinto beans, cocoa beans,.) Vegetables (tomatoes, onions, artichokes, broccoli, red cabbage, beets,.) Green leafy vegetables and herbs (kale), spinach, bok choy, artichokes, cilantro, thyme, basil,,) Spices (turmeric, cinnamon, cloves, cumin, ginger,.) Nuts (pecans, Brazil nuts, etc.), walnuts, hazelnuts,.) Also, the easiest way to tell if a food is high in antioxidants is by observing the color of the food.
The darker the color (like wild blueberries, spinach, or turmeric) the more antioxidants it contains. So, if at every meal, when you eat a variety of brightly colored foods, you are eating a variety of foods rich in antioxidants. In short, melasma and freckles are caused by the overproduction of melanin pigment in the skin.
Accordingly, if you know what to eat to get rid of melasma or what to eat to get rid of freckles as above, a diet from fresh foods and rich in antioxidants, limiting starch and avoiding inflammatory foods., irritation can help reduce darkening, resulting in a brighter and more radiant skin.
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What vitamins prevent melasma?
Vitamin C (Ascorbic Acid) for Melasma – Vitamin C is an effective natural melasma treatment as it is a tyrosinase inhibitor and an antioxidant- the most common skincare ingredients to treat pigmentation, Tyrosinase is the enzyme the body needs to make melanin pigment, so when you inhibit tyrosinase, you can lighten the skin.
- Oral vitamin C supplements may help melasma by protecting the skin from the sun, neutralizing free radicals that cause skin inflammation and blocking the production of melanin pigment.
- I recommend taking 500mg of Ascorbic acid two times a day.
- Boost your skin’s Vitamin C by also using a topical vitamin C serum for the best results to treat melasma,
Although oral Vitamin C has many benefits, taking it orally does not increase Vitamin C levels in the skin very much. It is best to target the skin with ascorbic acid from both the inside and outside. We like to prescribe Vitamin C topically as part of a Melasma Maintenance Routine to prevent melasma from coming back.
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What is the fastest way to cure melasma naturally?
6 completely natural ways to cure acute melasma – Blog What is melasma? Melasma is a skin disorder where your skin becomes brown and patchy. It most commonly appears on your cheeks, bridge of your nose, forehead, chin, or above your upper lip. It may also appear on the other parts of your body that are exposed to sunlight.
- Apply sunscreen 20 minutes before stepping out.
- Wear full sleeved tops and pants. Also, consider wearing a hat.
- You could try to apply two layers of SPF infused sunscreen. Apply a layer of SPF 15 and SPF 30 for double protection.
- If stress and hormonal imbalance are the reason behind melasma, try to make time for activities that help you relax, like walking or yoga.
- Use skin lightening lotions that contain Kojic acid or melaplex. These ingredients slow down the production of skin darkening and make it difficult for melasma to set in.
- Chemical peels are also a great way of lightening melasma. Thanks to the glycolic acid that’s available in a chemical peel, the first layer of skin that contains melasma will be peeled off.
- Another option is laser treatments. However, if you decide to opt for one, go for a restorative or fractional dual laser. These lasers only target pigmentation that’s on the surface of the skin.
Tips for melasma treatment at home If you’re not okay with chemicals, then you can always go for natural treatment for melasma. Below are few common ways to do so.
- Turmeric Turmeric contains curcumin, a strong antioxidant that results in lighter skin. Using a 1:2 ratio, mix milk with turmeric powder and apply the mixture on the affected areas. Let the pack dry completely and then rinse it with lukewarm water. Repeat this procedure every day for best results.
- Lemon Lemon is one of the most popular natural remedies for skin related disorders. Lemon is also known as a natural bleaching agent. All you have to do is apply lemon juice on the affected areas and leave it on for about 20 minutes. Wash it off with lukewarm water. Do this twice a day and you will see a noticeable difference in 3 weeks.
- Papaya Both raw and ripe papaya are used for curing various skin disorders. Papain, present in papayas, causes them to be the best home remedy for melasma. Mash a few pieces of papaya and mix it with honey. Apply the paste on affected areas and leave it for 20 minutes. Wash this pack off after 20 minutes. Do this once a week and for about 2-3 months.
- Aloe vera Aloe vera is an ingredient used in many face related products. It’s always best to use fresh aloe vera. Apply the gel, fresh off the plant, twice a day and massage your face for roughly two minutes. Leave it on for 15 minutes and wash off with lukewarm water.
- Onion There are a lot of home remedies for melisma, and onion juice is one of the best amongst them. Because onion contains sulfoxides and cepaenes, it helps in getting rid of melasma while also removing the blemishes. Mash the onion and mix it with apple cider vinegar, use a cotton ball and dab it all over the affected areas. After about 20 minutes, wash it off with lukewarm water. Repeat this twice a day for better results.
- Cucumber Cucumber is another home remedy that can be used for removal of pigmentation. Because cucumber is high in water content it lightens the pigmented skin. You simply have to grate the cucumber and apply it on affected areas. Wash it off with warm water after 20 minutes. Repeat this process once every day for best results.
Kaya’s treatment for melasma Kaya products are natural and reliable. Below are few things you can do with Kaya’s products to help treat melasma:
- Kaya’s Daily Moisturizing Sunscreen: Use Kaya’s Daily Moisturizing sunscreen before you step out. It contains SPF 30 that has both UVB and UVA protection. This lotion is grease free and absorbs into your skin well. Kaya’s Daily Moisturizing Sunscreen is suitable for all skin types and can be used every day.
- Kaya’s Youth Protect Sunscreen: Kaya’s Youth Protect Sunscreen comes with SPF 50 and ensures highest UVB and UVA protection. This product is PABA free, non-greasy, and suitable for all skin types.
- Kaya’s Pigmentation Reducing Complex: This cream reduces pigmentation marks and spots from your skin. It contains Azeloyl Diglycinate, Glyceryl Stearate, PEG-100 Stearate and Trimethyl Phenyl Silsesquioxane that prevents further darkening of the skin. The lotion absorbs really well into the skin and can be used for all skin types.
- Kaya’s Intense Clarity Peel: This is a unique peel that combines derma peels and botanical actives. These peels will naturally reduce the pigmentation and lighten the skin. It’s suitable for all skin types and you’ll see visible results in about 6 sessions.
- Kaya’s Insta Clarity Laser: This is Kaya’s latest technology that aims to reduce your pigmentation spots and marks. Kaya uses a Q-Switched laser that considered very safe for Indian skin. It’s an invisible beam that targets brown marks on the skin. The best part is you can return to your daily activities without any hassle. It’ll take about 6-8 sessions to see results.
For melasma, there are both, scientific and natural procedures that can be used for treatment. Kaya is a combination of both, offering scientifically proven products rooted in natural formulae to revive and rejuvenate your skin. : 6 completely natural ways to cure acute melasma – Blog
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What deficiency causes melasma?
Prevalence of Serum-Vitamin D Abnormalities, Periodontitis and Anaemia in Patients With Melasma – Full Text View Melasma, is a relatively common chronic pigmentation of the face, although it may be localized also on the neck and forearms. It is also called as chloasma or mask of pregnancy.
- It has higher prevalence in women and occurs less commonly in men.
- It most commonly affects the sun-exposed areas of skin of face.
- Three patterns of presentation have been reported: Centro-facial, malar and mandibular forms.
- The interplay of various risk factors are known to contribute in the pathogenesis of melasma such as genetic predisposition, ultraviolet radiation, hormonal factors, oral contraceptives and drugs like phenytoin.
Thyroid abnormalities were reported to occur with melasma. Skin pigmentation is a common manifestation in nutritional deficiencies and frequently associated with deficiency of vitamin B12, Increased iron may affect the pattern and course of pigmentation, however it is unclear how they coexist.
Vitamin D3 (cholecalciferol) is synthesized from 7-dehydrocholesterol by photochemical process in the skin and through successive hydroxylation to its active metabolite.1, 25-dihydroxyvitamin D3 is formed in liver and kidney. Intracellular receptor (VDR) helps in binding of vitamin D which helps the epithelial cells and melanocytes a target for vitamin D.
Although vitamin D is used in the treatment of melanoma and psoriasis and active role of 1, 25(OH)2D3 in skin no reports of melasma associated with vitamin D reported. The dysfunction of 1,25(OH)2D3 – VDR system may lead to periodontal disease, Mineral bone density could be directly related to deficiency of vitamin D which also progress to osteoporosis.
- Studies have reported that anemia may predispose to periodontitis but the correlation was not determined.
- Until date, no studies reported any correlation or mere association between melasma, periodontitis and serum vitamin D abnormalities as well as decreased Hb levels.
- The present study was intended to assess the presence of periodontitis and vitamin D deficiency in melasma patients and evaluate clinical presence of periodontitis, which may occur in conjunction with melasma and vitamin D deficiency.
The mere presence of melasma may help to investigate for further oral issues such as periodontitis and anemia which may or may not be associated with vitamin D abnormalities. Patients visiting the Dept. of Oral medicine, with melasma on face within the age group of 30-70yrs in either gender were included in the study, matched with similar control group without melasma after obtaining informed consent.
The patients were divided into 2 groups. Group A, had Patients with melasma in whom 2 ml of blood was collected for estimation of serum-vitamin D levels, and complete blood picture was estimated for Haemoglobin percentage and clinical oral examination was evaluated for periodontitis. Group B served as control arm, where same procedure of blood parameter estimation and clinical examination protocol was followed as in group A.
Total number of 100 patients participated in the study, 50 in each group. The samples that resulted out of recruitment were tabulated and appropriate statistical analysis was done comparing the both groups with the presence or absence of periodontitis and serum vitamin D abnormalities and serum Hb% levels.
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How can I stop melasma permanently?
How is melasma treated? What medicines help? – The first thing you need to do to treat your melasma is to make sure that it doesn’t get any worse. Do this by avoiding the sun, tanning beds, LED screens, irritating soaps and birth control that includes hormones.
- If you are exposed to the sun, be sure to wear sunscreen with iron oxides and a SPF of 30-50 applied every two hours, as well as a wide-brimmed hat.
- These steps may prevent your melasma from getting worse.
- The second path to take is topical medications.
- Topical therapy using tyrosinase inhibitors prevents new pigment formations by stopping the formation of melanin (the dark color).
Examples of tyrosinase inhibitors and other types of helpful agents include:
- Azelaic acid : This cream, lotion or gel is applied twice a day. It’s safe for pregnant women to use.
- Cysteamine : A small study of 50 people found cysteamine cream to be more effective than a placebo.
- Hydrocortisone (a topical corticosteroid) : Hydrocortisone helps fade the color caused by melasma. It can also lessen the likelihood of dermatitis that may be caused by other agents.
- Hydroquinone : This medication is applied as a cream or lotion. It goes directly onto the melasma patches at night for two to four months.
- Methimazole : Methimazole is an antithyroid cream or an oral tablet. It’s known to help melasma that resists hydroquinone.
- Soybean extract : Soybean extract is thought to reduce the transfer of color from the melanocytes to the skin cells.
- Topical alpha hydroxyacid : Epidermal pigments can be peeled off. This cream or chemical peel removes surface skin.
- Tranexamic acid : This is a cream or injection, or an oral medication.
- Tretinoin : This prescription is a topical retinoid. It’s effective, but can cause dermatitis and should not be used during pregnancy.
The combination of hydroquinone, tretinoin and a moderate topical steroid has had the best effect on melasma. Other agents that are being studied to improve melasma include:
- Absorbic acid (vitamin C).
- Arbutin.
- Deoxyarbutin.
- Glutathione.
- Kojic acid or kojic acid dipalmitate.
- Licorice extract.
- Mequinol.
- Resveratrol.
- Runicol.
- Zinc sulfate.
Dermatitis is a side effect of hydroquinone and tretinoin. Azelaic cream, lotion, or gel can sting. Always be on the lookout for any allergic reactions. Report all side effects to your healthcare provider. It might be appropriate for you to use a different medication to avoid the side effects.
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What is the main cause of melasma?
When you expose your skin to UV light, it triggers the body to produce more pigment. Sometimes, this pigment appears unevenly, causing the blotchy patches and freckle-like spots of melasma.
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What week does melasma start?
When Might Melasma Develop During Pregnancy? – Melasma appears most often during the second or third trimester, as hormonal changes increase. Estrogen and progesterone, which are thought to trigger it, start building after 12 weeks and peak around 32 weeks. Melasma can develop at any time during your pregnancy, however.
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How can I get light skin while pregnant?
Avocado – Avocado is a fruit that is known to be rich in vitamin C and vitamin E. Both these vitamins are known for their antioxidant properties. Vitamin C also helps in reducing inflammation and is essential for collagen production in the body. The production of collagen in turn improves your baby’s skin tone.
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Does folic acid help melasma?
How to Prevent Melasma – Limit sun exposure and apply sunscreen daily to prevent or avoid melasma worsening. Try to reduce your stress levels because stress raises cortisol levels, which can worsen melasma. To do so, sleep 7-8 hours every day and try meditation.
- Inflammation promotes pigmentation.
- Antioxidant and anti-inflammatory vitamins assist in preventing melasma by counteracting its effects.
- Antioxidants also help repair UV damage that causes melasma.
- Therefore, eat as many vitamins and antioxidant-rich things as possible, particularly foods high in vitamin C and E like citrus fruits, kiwis, pistachios, almonds, flaxseeds, colorful vegetables and fish (especially salmon).
In addition, eat foods high in folate because a folic acid deficiency can lead to melasma. Foods high in folate include citrus fruits, green leafy vegetables, nuts and whole grains. You may also need to adjust your copper intake. This is because copper causes extra skin pigmentation by promoting melanin production.
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What removes melasma?
Common melasma treatments – The most commonly used treatments for melasma are skin lightening medications that are applied topically. These include medications such as hydroquinone, azelaic acid, kojic acid, niacinamide, cysteamine, rucinol, and tranexamic acid.
- These medications work by reducing pigment production and inflammation, and by reducing excess blood vessels in the skin that contribute to melasma.
- Pregnant women (who constitute a big proportion of melasma patients) should avoid most of these medications except for azelaic acid, which is a safe choice during pregnancy.
Hydroquinone is a commonly used skin lightener that should only be used for a limited time due to side effects that may happen with prolonged use. It can be used for up to six months for initial treatment and then occasionally if needed. In most patients a combination therapy is needed for treatment for melasma.
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Which juice is good for melasma?
Lemon juice – The idea behind lemon juice to treat melasma is similar to that of apple cider vinegar. Many sites recommend rubbing the dark patches of skin with lemon juice and leaving it to dry before rinsing with water. Lemon juice is thought to lighten the skin because it is a bleaching agent.
Lemon juice is a popular DIY trick for brightening your laundry, but your skin is not your favorite shirt! Just like apple cider vinegar, the acidity from lemons can be harsh on the skin and cause irritation that may worsen your melasma. It isn’t clear whether lemon juice helps or harms your journey to a clear complexion since there haven’t been any studies about the effectiveness of this type of treatment.
However, this treatment may be harsh on your skin and cause more harm than good.
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What makes melasma worse?
Shun the sun – The next step in treating melasma is to prevent the sun from aggravating the condition. This may require extreme diligence. “The sun is stronger than any medicine I can give you,” says Dr. Kourosh. The most important way to clear up melasma is by using a strict sunscreen regimen.
sunscreens that use chemicals, such as oxybenzone sunscreens that use physical blockers, such as zinc and titanium dioxide.
“You want to choose the non-chemical, blocking sunscreen, because that will stop all the light and different wavelengths from coming through,” says Dr. Kourosh. Luckily, these sunscreens have come a long way from older formulations that sat on your skin in a greasy, white layer.
Today’s zinc and titanium dioxide formulas are micronized so they can sink into the skin, while still offering the same protection. You can buy them at your doctor’s office, skin care stores, or even the drugstore. “I’m not loyal to any specific brand,” says Dr. Kourosh. Chemical sunscreens don’t offer the same protection for melasma, and in some instances, they may even trigger allergic reactions that can make melasma worse, she says.
You can provide added protection to your skin by following up with makeup that contains a second sunscreen to further block out the sun’s rays. Even in the fall and winter it’s a good idea to wear a hat that is designed to provide sun protection, if you’re going to be outside for an extended period of time.
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Can iron deficiency cause melasma?
Authors: Azadeh Goodarzi, Elham Behrangi, Afsaneh Sadeghzadeh-Bazargan, Masoumeh Roohaninasab, Fatemeh Sadat Hosseini-Baharanchi, Mahsa Shemshadi, Elham Vafaei Abstract: Background — Melasma is a chronic acquired localized hypermelanosis, causing aesthetic problem for women and impairing their quality of life.
- Evidence has suggested that hyperpigmentation can occur as a result of iron deficiency anemia and vitamin B12 deficiency.
- Aim — We aimed to evaluate the serum parameters of iron profile in melasma patients.
- Material and Methods — This case-control study investigated 51 adult non pregnant women with melasma, compared with 51 controls, from patients referred to the Hospital, Tehran, Iran, 2017–2018.
Melasma was diagnosed clinically according to the melasma area and severity index (MASI) score was calculated and recorded by the physician. The groups were compared in terms of vitamin B12, folate, serum iron, hemoglobin (Hb), mean corpuscular volume (MCV), total iron binding capacity (TIBC), and ferritin.
- Results — The mean and standard deviation of the women’s age was 36.89±8.88 years, significantly higher in the group of patients with melasma.
- Comparing the serum parameters between the groups indicated no statistically significant difference in terms of mean levels of ferritin, Hb, MCV, iron, vitamin B12, TIBC, and folate.
The women in melasma group had a higher frequency in below normal range of ferritin and serum iron compared to the control group. None of the serum parameters were correlated with MASI. Conclusion — The higher frequency of below normal range of ferritin and serum iron levels in women with melasma compared to the control group showed a possible association between these serum parameters and melasma.
Cite as: Goodarzi A, Behrangi E, Bazargan AS, Roohaninasab M, Hosseini-Baharanchi FS, Shemshadi M, Vafaei E. The association between melasma and iron profile: a case-control study. Russian Open Medical Journal 2020; 9: e0202. Introduction Melasma is a chronic acquired disease of the skin, caused by melanogenesis dysfunction, resulting in localized hypermelanosis,
Although medically considered a benign lesion, the aesthetic complication of melasma can impair women’s quality of life and raise psychological concerns in the affected patients, As to the evidence, melasma occurs in all races, ethnic populations, and geographic areas; however, the incidence of melasma in the generalpopulation is not clear and most studies describe the prevalence only according to the dermatologic visits,
- Generally, a higher prevalence is reported in populations with a darker skin phenotypes (Fitzpatrick III and IV), including Hispanic and Latin Americans, Asians, Middle Eastern and Africans and a prevalence of about 40% is reported in Iranian women,
- Although the exact pathogenesis of melasma is uncertain, a combination of genetic predisposition, in addition to environmental factors, like sun exposure, have been suggested to play a role in its higher incidence in summer on exposed parts of the body,
The higher incidence in women, especially during pregnancy, is also attributed to the role of female hormones on occurrence of melasma, Hence, as melasma requires long–term treatment and the exact etiology is still unclear, research has focused on the underlying and attributing factors in order to take a step towards a better understanding of the disease.
In this regard, several serum parameters, like zinc, iron, copper, and magnesium, have been associated with skin lesions and melasma, Vitamin B 12 deficiency is also associated with hyperpigmentation and vitiligo, However, its association with melasma is doubted, Iron deficiency anemia is a public health problem with the highest prevalence in women of reproductive age the same population susceptible for melasma.
Evidence has suggested that hyper pigmentation can occur as a result of iron deficiency anemia and patients with melasma have been reported to have a lower serum levels of hemoglobin (Hb), iron, ferritin and total iron binding capacity (TIBC), Hence, these studies had several limitations, such as limited sample size and not controlling the effect of confounders, like endocrine disorders and using medications like oral contraceptives, which could affect the results.
- Therefore, for a definite conclusion, we aimed to compare the serum levels of vitamin B 12, folate, serum iron, Hb, mean corpuscular volume (MCV), TIBC, and ferritin between nonpregnant women with and without melasma controlling for confounders.
- Material and Methods Study sample The present case-control study investigated women with melasma who referred to the Dermatology Ward of the Rasoul Akram Hospital, Tehran, Iran, during 2017–2018.
The sample size was calculated at 51 in each group based on the mean serum iron level of the study by Qazi and colleagues, considering type I and II error of 0.05 and 0.20, respectively. Accordingly, a total of 102 women were investigated in two groups: 51 patients in the case group and 51 patients in the control group.
The inclusion criteria for both groups consisted of adult non–pregnant women aged 20 to 50 years old, with normal body mass index (BMI) (18.5–25 kg/m2), without autoimmune, thyroid or cardiac disease, pernicious anemia, celiac disease, Crohn’s disease, leukemia, or cancer, and without history of hormone replacement therapy, alcohol use, smoking, oral contraceptive pills (OCP), phototoxic drugs, phenytoin, spironolactone, vitamin B12, and folic acid during last six months, who referred to the selected hospital’s ward during the study period.
Furthermore, the participants without vegetarian habit were included. The participants of the case group were selected from patients with melasma by convenient sampling method from who referred to the Dermatology Ward of the hospital and participants of the control group were selected from patients who referred to other wards of the hospital, rather than dermatology, who were included by matching each control with each case.
Patients were included into the study, after the researcher explained the study objectives and methods to the participants and asked them to read and sign the written informed consent, if they desired to participate in the study. They were ensured that all their information will be kept confidential and analyzed without revealing their personal information.
Melasma diagnosis For the case group, all patients were visited by the clinic’s physician and diagnosis of melasma was made clinically, by wood lamp, after ruling out other dermatologic/inflammatory disorders, Also, themelasma area and severity index (MASI) score was calculated by the physician and recorded in the study checklist.
Variables For measurement of vitamin B12, folate, serum iron, Hb, MCV, TIBC, and ferritin, 15 cc venous blood sample was taken from participants of both groups, kept in refrigerator, and sent to the hospital’s laboratory immediately. Normal range of the serum parameters, the laboratory measurement techniques, and devices used are shown in Table 1.
Table 1. Comparing serum measurements between melasma and control groups adjusted for age in linear regression
| Variant | Normal range, laboratory measurement method and device name | Melasma | Control | P–value |
| Ferritin, ng/ml | 10–90, BT 3000 | 35.11±38.13 | 36.73±24.68 | 0.274 |
| Hemoglobin, g/dl | 12–16, Full diff Sismex | 13.05±0.98 | 13.07±0.79 | 0.986 |
| MCV, fl | 77–97 femtoliter | 86.93±4.95 | 84.88±5.61 | 0.589 |
| Serum iron, micg/dl | 40–155, Full diff Sismex | 65.90±31.90 | 61.72±24.39 | 0.403 |
| TIBC, micg/dl | 230–440, BT 3000 | 337.47±49.12 | 316±49.44 | 0.055 |
| Vitamin B 12, pg/ml | 211–946, electrochemiluminescence, (ECL, made in Germany, 2010) | 341.45±212.56 | 374±146.56 | 0.491 |
| Folate, ng/ml | 4.6–34.8, electrochemiluminescence, (ECL, made in Germany, 2010) | 11.01±6.25 | 13.13±6.04 | 0.058 |
Data presented as mean with standard deviation – M±SD. Statistical analysis Numbers with percentage and mean with standard deviation (M±SD) were used to describe qualitative and quantitative variables, respectively. Independent sample t–test was used to compare the quantitative variables with normal distribution. Kolmogorov-Smirnov test was used to investigate normality assumption. The comparison of the serum parameters between groups adjusted for significant covariates were done using multiple linear regression and logistic regression. Pearson’s correlation coefficient was calculated to evaluate the association between the MASI scores and the serum parameters. The statistical software IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp. Released 2013. Armonk, NY: IBM Corp), was used for statistical analysis. P-value less than 0.05 were considered significant. Results This study was completed by 51 women in the case group (with melasma) and 51 women without melasma (as the control group). The mean ±SD of the women’s age was 36.89±8.88 years. Table 2 shows that the characteristics of the women in melasma and control group were homogenous (P>0.05) except women’s mean age which had a statistically significant difference between case and control groups (41.45±6.18 vs.32.33±8.86, respectively) (P 0.5). Table 2. Comparison the characteristics of the women in melasma and control group
| P–value | Control | Melasma | Characteristic | ||
| <0.001 | 32.33±8.86 | 41.45±6.18 | – | Age, year, M±SD | |
| 0.074 | Family history of melasma | ||||
| 20 (39) | 29 (57) | Yes | |||
| 31 (61) | 22 (43) | No | |||
| 0.192 | Using sunscreen, n (%) | ||||
| 19 (37) | 29 (57) | Yes | |||
| 32 (63) | 22 (43) | No | |||
| 0.685 | Employment, n (%) | ||||
| 30 (59) | 32 (63) | housewife | |||
| 21 (41) | 19 (37) | Employed | |||
| 0.308 | Marital status, n (%) | ||||
| 50 (98) | 48 (94) | Married | |||
| 1 (1) | 3 (6) | Single | |||
| 0.295 | Duration expose to sun (hour), n (%) | ||||
| 16 (32) | 10 (19) | <1 | |||
| 30 (60) | 34 (67) | 1-2 | |||
| 4 (8) | 7 (14) | >2 | |||
M±SD – data presented as mean with standard deviation; n (%) – data presented as numbers and percentages. The patients’ serum parameters are compared between the groups in Table 2. As indicated, there was no statistically significant difference between the groups in mean serum levels offerritin, Hb, MCV, iron, vitamin B 12, TIBC, and folate adjusted for female age (P>0.05). The serum parameters were categorized based on the normal range of each serum parameter and compared between the groups as shown in Table 3. It was showed that the odds of melasma for the female with below normal range of ferritin level (<10) was 4.07 (1.2, 13.8) than the odds of melasma for the female with normal ferritin level (P=0.023). The female with below normal range of iron level had the risk of melasma 3.99 (1.04, 15.25) than the female with normal iron level (P=0.042). In addition, below normal range level of MCV decreased risk of female's melasma, however, it was not statistically significant ( Table 3, P=0.814). It was observed that the risk of melasma was higher in females with below normal range level of HB (P=0.79), Vitamin B12 (P=0.058), and folate (P=0.158) in comparison to the females with that of in normal range. It was observed that the risk of melasma was lower in females with below normal range level of TIBC (P=0.814) and MCV (P=0.8) in comparison to the females with that of in normal range. Table 3. Odds Ratio (95% confidence interval (CI)) for each serum parameter between the case and control groups adjusted for age
| Serum parameter | Categories | Melasma | Control | Odds Ratio (95% CI) | P-value |
| Ferritin, ng/ml | <10 | 17(33) | 5(9.8) | 4.07 (1.2, 13.8) | 0.023 |
| 10–90 * | 29(56.9) | 44(86.3) | 1 | ||
| >90 | 5(9.8) | 2(3.9) | 0.93 (0.11, 7.53) | 0.940 | |
| Hemoglobin, g/dl | <12 | 5(9.8) | 5(9.8) | 1.22 (0.27, 5.63) | 0.791 |
| >12 | 46(90.2) | 46(90.2) | 1 | ||
| MCV, fl | <77 | 1(2) | 3(5.9) | 0.73 (0.06, 8.5) | 0.800 |
| 77–97 * | 49(96.1) | 48(94.1) | 1 | ||
| >97 | 1(2) | 0(0) | – | ||
| Iron, micg/dl | <40 | 11(21.6) | 5(9.8) | 3.99 (1.04, 15.25) | 0.042 |
| 40–155 * | 39(76.5) | 46(90.2) | 1 | ||
| >155 | 1(2) | 0(0) | – | ||
| TIBC, micg/dl | <230 | 1(2) | 2(3.9) | 1.4 (0.09, 21.8) | 0.814 |
| 230–440* | 49(96.1) | 49(96.1) | 1 | ||
| >440 | 1(2) | 0(0) | – | ||
| Vitamin B 12, pg/ml | <211 | 13(25.5) | 5(9.8) | 3.47 (0.95, 12.6) | 0.058 |
| 211–946* | 36(70.6) | 46(90.2) | 1 | ||
| >946 | 2(3.9) | 0(0) | – | ||
| Folate, ng/ml | <4.6 | 4(7.8) | 1(2) | 5.7 (0.51, 63.1) | 0.158 |
| 4.6–34.8* | 47(92.2) | 50(98) | 1 | ||
| >34.8 | 0(0) | 0(0) | – |
Normal range was considered as the reference group, † Significant difference, in the case of zero frequency, the associated cell is omitted in the logistic regression modelling. Table 4 shows the assessment of the correlation between MASI and serum parameters in which none of the serum parameters were significantly associated with MASI (P>0.05). Table 4. The Pearson’s correlation coefficient between the MASI score and the serum parameters
| Variant | Correlation | P-value |
| Ferritin | -0.11 | 0.45 |
| Hemoglobin | -0.10 | 0.48 |
| MCV | 0.20 | 0.15 |
| Iron | 0.03 | 0.81 |
| TIBC | -0.15 | 0.29 |
| Vitamin B 12 | 0.16 | 0.24 |
| Folate | -0.03 | 0.83 |
Discussion This study showed a higher frequency of below normal range ferritin level and serum iron levels in women with melasma, compared to the control group. Risk of melasma for the female with below normal range of ferritin level as well as iron was significantly higher than that of the patients with normal level which could imply the role of these serum parameters on melasma.
According to the evidence, hyperpigmentation is a symptom of vitamin B 12 deficiency, presenting prior to neurologic symptoms, Vitamin B 12 is an important cofactor for methionine synthaseand its deficiency results in impaired methylation and DNA synthesis of haemoglobin and accumulation of homocysteine,
In melanogenesis, hyperpigmentation occurs due to depletion of intracellular glutathione, which inhibited tyrosinase activity, Babaie and colleagues tested the serum level of vitamin B 12 in melasma and reported that only 1/70 had a deficient vitamin B 12 level, while in the present study 13/51 women (25.5%) had a deficient vitamin B 12 level.
This discrepancy between the results of the studies can be due to the different inclusion and exclusion criteria, as we excluded all patients who have used folic acid or vitamin B 12 supplementation, as well as different cut-off levels determined for vitamin B 12 deficiency. In addition, Babaie et al did not compare the results with a control group.
In our study, comparing the frequency of vitamin B 12 deficiency between the case and controls revealed a nonsignificant association between melasma and vitamin B 12 deficiency. Although studies have determined the role of vitamin B 12 deficiency in different skin lesions and hyperpigmentation), no other study has determined its deficiency in patients with melasma, and this study, as far as the authors are concerned, is the first to compare its level with a control group with nonsignificant association.
Moreover, it was found that the mean serum levels of Hb, MCV, iron, vitamin B 12, TIBC, and folate were not different between the groups. Moreover, Hb, MCV, vitamin B12, TIBC, and folate these serum parameters were not associated with melasma risk. TIBC represents the sum of all iron binding sites on transferrin, which tightly binds to the cell receptor and controls iron release into plasma; serum iron will be used by various cells and excess levels of iron will be stored as metabolically inactive form, ferritin,
TIBC is thus measured in diagnosis of iron deficiency anemia, iron overload, and chronic inflammatory disorders, The higher TIBC level in women with melasma showed lower iron storage, although the majority of the patients in both groups was within the normal range of TIBC.
The lower iron storage of the patients with melasma was confirmed by a higher frequency of below normal range ferritin level. The results of the present study indicated that women with melasma have a higher frequency of anemia, and also have a lower iron storage. Also, the nutritional habits of patients can significantly affect the serum levels of these parameters, although we excluded vegetarians to minimize the confounding effect of nutrition on melasma and iron profile.
Behrangi and colleagues compared the iron profile of 33 women with melasma with a control group and reported no significant difference between the groups in serum iron, ferritin or TIBC, Their results confirmed that of the present study on no difference between the patients with melasma and the control group in terms of TIBC, but were inconsistent with the results of the present study in terms of serum ferritin and serum iron levels.
This discrepancy could be due to the difference of the baseline serum level of ferritin and serum iron in the study population. In the present study, we tried to exclude any patients with chronic diseases or supplementation use to control the confounders affecting TIBC, serum iron, and ferritin levels.
Babaie et al reported low Hb and serum iron levels in 14.3% and 8.6% of women with melasma, while in the present study, 9.8% of patients with melasma had low Hb level and 21.6% had low serum iron level. This difference can be attributed to the different frequency of anemia in different populations and may also differ according to the underlying diseases and different age groups of the studied population,
In the present study, the mean age of the groups had significant differences, which could also be attributed to different iron profile, so we adjusted the analysis regarding the age difference. The study by Qazi et al (2017), comparing 70 nonpregnant women with melasma and the control group, showed a lower mean serum iron and ferritin levels, beside a higher TIBC in the case group,
These results showed a higher frequency of anemia and lower iron storage in women with melasma, which was consistent to the results of the present study, although the Hb and TIBC levels did not differ between the groups in our study and lower iron storage, was indicated by the lower mean serum iron and higher frequency of below normal range ferritin level.
These results could indicate that women with melasma had low iron levels and storage, but as far as evident in thevitaminB 12 and folate although mean levels were lower in melasma group but they were not expressive enough, which could be followed by future studies. In the present study, all variables were tested for association with MASI, but the results showed no significance.
On the contrary to these results, Qazi et al stated a positive correlation between MASI score and iron profile, which could be also due to the lower mean serum iron in the study by Qazi et al, while only reduced iron storage was detected in the patients of the present study.
Anemia is a prevalent health problem, especially in women of reproductive age, who are the main target population of melasma, a disturbing skin disease in women, impairing patients’ quality of life, The target population of the highest frequency of anemia and melasma are the same. Furthermore, the frequency of melasma seems to be higher in pregnant women due to the increased levels of placental, ovarian and pituitary hormones, which results in increased transcription of tyrosinase and dopachrome tautomerase and pigmentation during pregnancy,
The same population, pregnant women, have a high frequency of anemia, These two, the higher frequency of anemia and melasma during pregnancy, may be associated with each other, which have to be further investigated. In the present study, we did not include pregnant women, due to the complex situations and hormone secretion in pregnancy, which may affect this association.
- The present study could successfully compare all these parameters between the case and control groups, while the one study investigating all these parameters had the major limitation of a small sample size.
- Like any other study, our study could also have several limitations.
- First, the participants did not match with each other in terms of demographics.
Second, all participants were selected from one center that reduce the generalizability of the results. Furthermore, the case-control nature of the study limited confirming causal relationships, although there was no statistically significant association between the variables.
- Meanwhile, as the first valid study to investigate this association in an Iranian population, the present study could provide valuable information for the researchers and clinicians.
- Conclusion The results of the present study showed that the iron profile of women with melasma is different from that of controls.
The higher frequency of below normal range ferritin and serum iron levels in the case group showed the possible role of anemia in melasma. Limitations Although lower frequency of above normal range vitamin B 12 and folate showed a lower iron storage in women with melasma, the initial hypothesis of the study (the association of melasma as hyperpigmentation with vitamin B 12 and serum folate deficiency) was not confirmed, as hemoglobin and MCV levels were not different between the groups.
Although we excluded possible factors that could affect vitaminB 12 and serum folate levels and pathogenesis of hyperpigmentation and melasma, there could be several factors affecting the two multifactorial diseases, vitaminB 12 deficiency and melasma, which could not be controlled in the present study.
Future randomized clinical trial or cohort studies can shed light on the association between serum folate and vitaminB 12 and melasma. Ethical approval The study was approved by the Ethics Committee of Iran University of Medical Sciences (code: IR.IUMS.FMD.REC1395.08921215097), and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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New Delhi: Jaypee Brothers Medical Publisher, 2015: 1-3. https://doi.org/10.5005/jp/books/12401_2, Edalatkhah H, Amani F, Rezaifar G. Prevalence of melasma in women in Ardebil city in 2002. Iran J Dermatol 2004; 7(2): 72-77. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=48038, Mahmood K, Nadeem M, Aman S, Hameed A, Kazmi AH. Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females. J Pak Assoc Dermatol 2016; 21(4): 241-247. http://www.jpad.com.pk/index.php/jpad/article/view/483, Lajevardi V, Ghayoumi A, Abedini R, Hosseini H, Goodarzi A, Akbari Z, et al. Comparison of the therapeutic efficacy and safety of combined oral tranexamic acid and topical hydroquinone 4% treatment vs. topical hydroquinone 4% alone in melasma: a parallel-group, assessor- and analyst-blinded, randomized controlled trial with a short-term follow-up. J Cosmet Dermatol 2017; 16(2): 235-242. https://doi.org/10.1111/jocd.12291, Amin N, Mashhood AA, Bilal A. 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About the Authors: Azadeh Goodarzi – MD, Assistant Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. https://orcid.org/0000-0002-1249-4429, Elham Behrangi – MD, Associate Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Https://orcid.org/0000-0002-6545-3460,
- Afsaneh Sadeghzadeh Bazargan – MD, Assistant Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Https://orcid.org/0000-0003-1102-6241,
- Masoomeh Rohaninasab – MD, Assistant Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
https://orcid.org/0000-0002-2862-6422, Fatemeh Sadat Hosseini-Baharanchi – MA, MS, PhD, Assistant Professor, Minimally Invasive Surgery Research Center, & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
- Https://orcid.org/0000-0003-1633-2635.
- Mahsa Shemshadi – MD, Resident of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Https://orcid.org/0000-0002-6912-0532,
- Elham Vafaei – MD, General Practitioner, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
https://orcid.org/0000-0002-5684-6625, Received 9 June 2019, Revised 4 August 2019, Accepted 18 February 2020 © 2019, Goodarzi A., Behrangi E., Sadeghzadeh-Bazargan A., Roohaninasab M., Hosseini-Baharanchi F.S., Shemshadi M., Vafaei E. © 2019, Russian Open Medical Journal Correspondence to Elham Vafaei.
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How can I prevent melasma naturally?
6 completely natural ways to cure acute melasma – Blog What is melasma? Melasma is a skin disorder where your skin becomes brown and patchy. It most commonly appears on your cheeks, bridge of your nose, forehead, chin, or above your upper lip. It may also appear on the other parts of your body that are exposed to sunlight.
- Apply sunscreen 20 minutes before stepping out.
- Wear full sleeved tops and pants. Also, consider wearing a hat.
- You could try to apply two layers of SPF infused sunscreen. Apply a layer of SPF 15 and SPF 30 for double protection.
- If stress and hormonal imbalance are the reason behind melasma, try to make time for activities that help you relax, like walking or yoga.
- Use skin lightening lotions that contain Kojic acid or melaplex. These ingredients slow down the production of skin darkening and make it difficult for melasma to set in.
- Chemical peels are also a great way of lightening melasma. Thanks to the glycolic acid that’s available in a chemical peel, the first layer of skin that contains melasma will be peeled off.
- Another option is laser treatments. However, if you decide to opt for one, go for a restorative or fractional dual laser. These lasers only target pigmentation that’s on the surface of the skin.
Tips for melasma treatment at home If you’re not okay with chemicals, then you can always go for natural treatment for melasma. Below are few common ways to do so.
- Turmeric Turmeric contains curcumin, a strong antioxidant that results in lighter skin. Using a 1:2 ratio, mix milk with turmeric powder and apply the mixture on the affected areas. Let the pack dry completely and then rinse it with lukewarm water. Repeat this procedure every day for best results.
- Lemon Lemon is one of the most popular natural remedies for skin related disorders. Lemon is also known as a natural bleaching agent. All you have to do is apply lemon juice on the affected areas and leave it on for about 20 minutes. Wash it off with lukewarm water. Do this twice a day and you will see a noticeable difference in 3 weeks.
- Papaya Both raw and ripe papaya are used for curing various skin disorders. Papain, present in papayas, causes them to be the best home remedy for melasma. Mash a few pieces of papaya and mix it with honey. Apply the paste on affected areas and leave it for 20 minutes. Wash this pack off after 20 minutes. Do this once a week and for about 2-3 months.
- Aloe vera Aloe vera is an ingredient used in many face related products. It’s always best to use fresh aloe vera. Apply the gel, fresh off the plant, twice a day and massage your face for roughly two minutes. Leave it on for 15 minutes and wash off with lukewarm water.
- Onion There are a lot of home remedies for melisma, and onion juice is one of the best amongst them. Because onion contains sulfoxides and cepaenes, it helps in getting rid of melasma while also removing the blemishes. Mash the onion and mix it with apple cider vinegar, use a cotton ball and dab it all over the affected areas. After about 20 minutes, wash it off with lukewarm water. Repeat this twice a day for better results.
- Cucumber Cucumber is another home remedy that can be used for removal of pigmentation. Because cucumber is high in water content it lightens the pigmented skin. You simply have to grate the cucumber and apply it on affected areas. Wash it off with warm water after 20 minutes. Repeat this process once every day for best results.
Kaya’s treatment for melasma Kaya products are natural and reliable. Below are few things you can do with Kaya’s products to help treat melasma:
- Kaya’s Daily Moisturizing Sunscreen: Use Kaya’s Daily Moisturizing sunscreen before you step out. It contains SPF 30 that has both UVB and UVA protection. This lotion is grease free and absorbs into your skin well. Kaya’s Daily Moisturizing Sunscreen is suitable for all skin types and can be used every day.
- Kaya’s Youth Protect Sunscreen: Kaya’s Youth Protect Sunscreen comes with SPF 50 and ensures highest UVB and UVA protection. This product is PABA free, non-greasy, and suitable for all skin types.
- Kaya’s Pigmentation Reducing Complex: This cream reduces pigmentation marks and spots from your skin. It contains Azeloyl Diglycinate, Glyceryl Stearate, PEG-100 Stearate and Trimethyl Phenyl Silsesquioxane that prevents further darkening of the skin. The lotion absorbs really well into the skin and can be used for all skin types.
- Kaya’s Intense Clarity Peel: This is a unique peel that combines derma peels and botanical actives. These peels will naturally reduce the pigmentation and lighten the skin. It’s suitable for all skin types and you’ll see visible results in about 6 sessions.
- Kaya’s Insta Clarity Laser: This is Kaya’s latest technology that aims to reduce your pigmentation spots and marks. Kaya uses a Q-Switched laser that considered very safe for Indian skin. It’s an invisible beam that targets brown marks on the skin. The best part is you can return to your daily activities without any hassle. It’ll take about 6-8 sessions to see results.
For melasma, there are both, scientific and natural procedures that can be used for treatment. Kaya is a combination of both, offering scientifically proven products rooted in natural formulae to revive and rejuvenate your skin. : 6 completely natural ways to cure acute melasma – Blog
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