Melasma can be a very frustrating and destabilising skin condition to deal with. Topical treatment can be quite effective, however many experiencing this skin condition deal with recurrence of the pigment all too soon. So why is this happening and what can we do about it with holistic medicine?
Melasma is a pigmentation of the skin that appears as darker or pigmented patches generally appearing on the face, around the cheeks, chin, upper lip, bridge of the nose and forehead, but can also appear on areas of the body such as neck and forearms. Women suffer with Melasma more frequently, making up 90% of cases and melasma occurs in a general sense, due to an upregulation of melanin production in the pigmented area. Melasma presents in women of reproductive age, and we see it in as high as 50% of pregnant women. The oral contraceptive pill has also been known to initiate the first appearance of melasma. It’s through these connections that studies were designed to identify that higher levels of oestrogen, play a role in Melasma pigmentation. Research has shown that oestrogen upregulates an enzyme called tyrosinase, that increases melanin or pigment production in melanocytes. Connections to natural and synthetic progesterone have also been noted but the research findings are sometimes contradictory at this point.
Thyroid health has been connected to melasma in several studies. There is a correlation between multiple thyroid presentations and melasma, with the strongest being autoimmune thyroid disease known as Hashimoto’s. As high as 58% of melasma sufferers have been found to also present with a thyroid disorder. If you have a family history of hypothyroidism or feel you have symptoms of a thyroid disease, it’s a good idea to have your thyroid function assessed, specifically thyroid antibodies. You can speak to your GP, naturopath or nutritionist about having thyroid tests run to assess if your thyroid health is prolonging melasma. Thyroid support recommendations for natural treatments are specific to your test results and thyroid presentation. There are some thyroid support supplements you shouldn’t use without knowing what type of thyroid dysfunction you are experiencing so working with a practitioner is helpful.
Stress and the physiological inflammation generated by emotional stress, known as oxidative stress, have been linked to Melasma. Stress hormone called cortisol can also upregulate oestrogen production, so it’s good to deal with chronic stress to assist Melasma resolution. This can be done with psychology support, herbal medicine, nutritional supplements or tools such as meditation and exercise.
Natural Internal Melasma Treatment Options
Healthy oestrogen clearance can be supported by several supplements. First it is important to know if you have elevated free oestrogen and if you are producing toxic forms of estrogen in your liver instead of detoxing it in a healthy way. Depending on which sort of estrogen excess is present you would use different supplements. So ideally you would have a functional urine hormone metabolite test run by your naturopath or nutritionist. If you don’t have access to this, you can have a blood test run for free oestrogen called estradiol. If estradiol is elevated, you can use a DIM supplement alongside calcium D-glucarate to assist healthy clearance. If your blood test does not show elevated estradiol but you feel you have symptoms of oestrogen excess, using glutathione or a methylation support supplement such as methylated B12, would be better formulas. This is to assist healthy oestrogen detoxification and lower any strong toxic forms of oestrogen, that are being produced by your liver, that don’t show up on a blood test.
Glutathione is a strong antioxidant with additional anti-melanogenic properties therefore decreasing Melanin in skin cells. Glutathione dose is, alongside its ability to detoxify strong and negative form of oestrogen, called 4-Hydroxyestradiol, making it a perfect all round Melasma supplement.
Niacinamide and Vitamin C
Niacinamide or B3 supplementation has been seen to reduce inflammation in the body and in this way has reduced inflammatory acne and rosacea in research. So, the same anti-inflammatory action is helpful in Melasma, especially where thyroid or stress are part of the presentation. Niacinamide is great at protecting our skin cells from UV exposure and has been seen to decrease melanin uptake by surrounding surface skin cells called keratinocytes. Vitamin C has also been shown to inhibit tyrosinase the enzyme that produces melanin or pigment in skin cells.
Of course, I should also tell you to wear SPF30+ or higher every day and a hat when out in direct sunlight, but your probably already aware of proper sun protection and the effect of UV on Melasma. As always holistic natural medicine approaches are person specific, and the treatment approach needs to match your unique health story and Melasma drivers. If you feel unsure of where to start it’s probably best to work with a practitioner, you feel comfortable being guided by.