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MELASMA COSMELAN WORKSHOP 2009
COSMELAN® STILL RELEVANT IN SKIN HYPER-PIGMENTATION:
Leenyx Technologies™ hosted a HPCSA accredited workshop on 20 October 2009 to high-light the stubborrness and resistance of melasma (chloasma) to topical and light therapy. The workshop was held in the Conference Centre of The Louis Leipoldt Hospital, one of the Medi-Clinic Group Hospitals, in Bellville. A multi-disciplinary approach and speakers was arranged and speakers were selected from the basic sciences, and clinical medicine (aesthetic physician and academic dermatologist). The discussion was also to probe what role lasers play a role in the treatment of melasma. Each speaker’s presentation is briefly summarised. |
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DR WILLIE VISSER: SENIOR SPECIALIST ACADEMIC DERMATOLOGIST at the University of Stellenbosch and Tygerberg Hospital.
- Melasma is a common skin disorder and strongly related with sun-damage, genes and hormones, and pregnancy.
- The condition increases with age and dark lesions need differentiating from malignant melanoma.
- In the Western-world the treatment of choice is topical hydroquinone and in combination and the use is supported by the medical literature. Many studies from the dermatological literature show that double and triple therapy render a higher response rate. In some parts of the world the product is not on code, supposedly because of complications. On the other hand the safety profile is known. It is a prescription drug is but often smuggled over or under the counter by merchants to clients seeking these skin-lightening agents.
- Melasma in most patients is a chronic disorder, not reversible (incurable) but can be improved. Recurrence rate is almost 100% at 6-12 months.
- Various lasers have been studied in the treatment of melasma but the long-term results, regarding, recurrence of the skin disorder is poor.
- Therefore in almost cases, treatment is palliative and recurrence is the norm. The condition is harmless and is commonly found in octogenarians without any symptoms at all.
- Hydroquinone and combinations is cost effective treatment and far cheaper than 4 or more treatments with a laser. Sunscreens are important.
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| DR LIZELLE BOTHA (AESTHETIC PHYSICIAN FROM BELLVILLE) has found the use of Dermamelan/Cosmelan® of value in younger persons. The skin response she has measured with the VISIA® device to assess efficacy of Dermamelan/Cosmelan®. At 6 months follow-up after treatment the scans are encouraging with reduced pigmentation, reduction in fine-lines and improvement in texture. Dr Botha recommends that long-term topical treatment with the product is needed thereafter to reduce recurrence. Sunscreens are important. 20% glycolic-acid peels (Neostrata®) can also render modest skin depigmentary-results, confirming the efficacy of chemical peels in the treatment of epidermal melasma. |
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PROFESSOR DON DU TOIT, FROM THE DEPARTMENT OF BIOMEDICAL SCIENCES, at the University of Stellenbosch, in cadaveric studies showed that melasma is a chronic disorder, and increases with age. Even deep peels would be destined to failure. And perhaps the only device that would work is a Co2 laser. But that treatment is very harsh and leads to scarring. Even the results of mosaic and Fraxel ® lasers are controversial and very costly. From histological studies, it would appear that only superficial epidermal melasma is amenable to a soft chemical peel. In most cases a deep peel is destined to failure, based on the histological findings of melanin staining in the deeper areas of the dermis.” Dermal or melanin incompetence” is insensitive to all recognised treatments. Dermamelam/Cosmelan® would therefore be beneficial to patients with epidermal melasma and results in the literature do confirm this. Possibly in all cases, the Wood’s Light is needed to guide the practitioner make decisions about treatment in melasma. Another tough condition to treat is pigmented molluscum sebaceum that occurs with the outcroppings of solar-lentiges on the hands, arms, face and neck.
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 CONCLUSIONS. From a cost point of view hydroquinone (1-5%) or in combinations, cannot be beaten in the treatment of skin hypermelanosis. The dermatological literature supports this view. Melasma is a chronic, incurable condition and mostly harmless. Temporary amelioration is possible. Dermamelan/Cosmelan® has a place in epidermal-melasma but chronic topical application together with sunscreens is mandatory. Deep dermal hypermelanosis is incurable and the place of lasers is still undefined in deep-seated melasma where the dangers of post-procedural hyper-pigmentation and scarification is high. Surveillance for malignant melanoma is important.
WEBSITE POSTING: New version high-lighting lasers was posted on 3 November 2009.
DISCLAIMER: This website gives no advice on treatment. The client must consult a dermatologist, plastic surgeon or aesthetic physician.
 
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