Earlier we posted a blog about pigment reduction by dietary supplements. Questions about this poured in and most questions were about melasma or ‘pregnancy mask’. Melasma remains a challenging skin condition for both women and men. Even though it is a cosmetic problem, it can have a negative psychological effect. Read more about pigmentation; more than just a cosmetic problem.
In addition to the usual melasma treatments such as sun protection, pigment-reducing creams, peels and lasers, new treatment methods are being sought. A question that then comes to mind is: can dietary supplements reduce and perhaps even cure melasma? After all, a treatment is successful when the condition does not recur.
What do the studies say about this?
Well-designed studies on this are limited, but worth reading.
Tranexamic acid is a synthetic variant of the amino acid ‘lysine’. It is used as a hemostatic agent to prevent heavy bleeding. Its use in the treatment of melasma was first reported in 1979. Tranexamic acid inhibits pigment production.
One of the largest studies was conducted in 2012 among 260 patients with melasma. In a randomized trial, patients were divided into two groups. Group 1 received routine treatment (sun protection + hydroquinone cream) and 250 mg tranexamic acid twice a day for 3 months. For group 2, treatment consisted of sun protection and hydroquinone cream. Conclusion: Routine treatment with tranexamic acid in group 1 was significantly better.
A smaller, randomized study of 48 patients with melasma also divided these patients into two groups. Group 1 was treated only with triple cream for 2 months (class 2 hormone, tretinoid 0.05% and hydroquinone 2%) and group 2 received tranexamic acid 250 mg twice a day, combined with triple cream. After two months there was a better result in group 2 with the combination of tranexamic acid and triple cream.
So a combination of bleaching cream, sun protection and tranexamic acid is better. The treatments have taken place under the strict medical supervision of doctors experienced with tranexamic acid.
Polypodium leucotomos extract (PLE).
PLE is a fern extract and belongs to the Polypodiaceae family. It has antioxidant and immunoprotective effects. In a double-blind randomized study with placebo, 40 people with melasma were divided into 2 groups and followed for 3 months. One group received a placebo, combined with SPF50+ and hydroquinone 4% cream and the other group received PLE extract (2 x a day 480 mg), SPF50+ rubbing and also hydroquinone cream 4%. Conclusion after 3 months: the group with PLE, sun protection and hydroquinone 4% cream is significantly better.
Carotenoids are naturally occurring pigments derived from plants, algae, fruits and vegetables such as tomatoes and tomato paste. They have anti-inflammatory, antioxidant effect and to some extent give protection against harmful ultraviolet rays.
In a double-blind placebo-controlled and randomized study with 44 melasma patients, they received 800 mg carotenoids or a placebo daily for 84 days. In addition, they received a skin care cream containing niacinamide, kojic acid and arbutin and protection during the day with a mineral (zinc oxide and titanium dioxide) sunscreen. In the group with carotenoids, melasma symptoms improved. Aside note from Francis Wu: a limitation of the study is that the patient number is too small and long-term use of carotenoids gives temporary orange skin discoloration. It is a safe option without many side effects.
Procyanidin (Pinus pinaster)
Procyanidin is a flavonoid and the extract comes from the French maritime pine tree (Pinus pinaster). It is not known exactly how this extract can inhibit hyperpigmentation of the skin. Procyanidin is a strong antioxidant and has anti-inflammatory properties, which may play a role. The antioxidant effect is enhanced when combined with vitamins C and E.
A randomized, double-blind, placebo-controlled trial of oral procyanidin combined with vitamin A, C, and E supplements versus placebo for women with melasma. Sixty female Filipino women with melasma were randomized to take 24 mg oral procyanidin, 6 mg b-carotene, 60 mg vitamin C, and 15 IU vitamin E twice daily for 2 months. The placebo tablets looked the same. Conclusion: The treated women with the procyanidin and vitamin combination showed a significant improvement with hyperpigmentation reduction. De tabletten met de actieve ingrediënten waren goed tolereerbaar met minimale bijwerkingen. The only side effect was a metallic taste, which disappeared after stopping the tablets.
What are your thoughts on this, Francis?
Melasma is a challenging condition, but there are new insights and other approaches to at least reduce hyperpigmentation. In my opinion, a multi-level approach is better than just a pale cream or sunscreen. The approach certainly includes topical sun protection and pigment reduction with the right ingredients, but also peels and lasers. And an addition to the treatment strategy are oral supplements.
Finally, this approach isn’t just for dermatologists; it is a collaboration with beauticians and skin therapistn. Multi-level is not only a treatment strategy but also a multi-horizontal collaboration.
How can Iconic Elements help you?
Iconic Elements has two products, the Spot Reducer and the Targeted Pigment Serum, that can be particularly effective in treating pigment spots. Here’s how they work and why they’re effective:
Niacinamide (Vitamin B3): Both the Spot Reducer and the Targeted Pigment Serum contain niacinamide, an exceptional ingredient known for its ability to brighten the skin. Niacinamide regulates the production of melanin, the pigment responsible for dark spots on the skin. This causes pigment spots to gradually fade and the complexion becomes more even.
Arbutin: The Targeted Pigment Serum contains arbutin, a natural ingredient derived from plants. Arbutin is known for its ability to reduce hyperpigmentation. It inhibits the activity of tyrosinase, an enzyme involved in the production of melanin. This makes the complexion more even and reduces dark spots.
Malic Acid:This ingredient, found in the Targeted Pigment Serum, has mild exfoliating properties. It helps remove dead skin cells and improves the overall texture of the skin. This contributes to reducing the visibility of pigment spots.
Piyavatin P, Chaichalotornkul S, Nararatwanchai T, Bumrungpert A, Saiwichai T. Synbiotics supplement is effective for Melasma improvement. J Cosmet Dermatol. 2021 Jan 21.
Karn D, Kc S, Amatya A, Razouria EA, Timalsina M. Oral tranexamic acid for the treatment of melasma. Kathmandu Univ Med J (KUMJ). 2012 Oct-Dec;10(40):40-3. doi: 10.3126/kumj.v10i4.10993. PMID: 23575051.
Padhi T, Pradhan S. Oral Tranexamic Acid with Fluocinolone-Based Triple Combination Cream Versus Fluocinolone-Based Triple Combination Cream Alone in Melasma: An Open Labeled Randomized Comparative Trial. Indian J Dermatol. 2015 Sep-Oct;60(5):520
Goh CL, Chuah SY, Tien S, Thng G, Vitale MA, Delgado-Rubin A. Double-blind, Placebo-controlled Trial to Evaluate the Effectiveness of Polypodium Leucotomos Extract in the Treatment of Melasma in Asian Skin: A Pilot Study. J Clin Aesthet Dermatol. 2018;11(3):14-19.
Teo WL, Gan E, Jinghan A, et al. Double blind placebo controlled trial to evaluate of the effectiveness of a dietary supplement rich in carotenoids as adjunct to topical lightening cream for the treatment of melasma: a pilot study. J Pigment Disord 2015; 2: 164
Rostami Mogaddam M, Safavi Ardabili N, Iranparvar Alamdari M, Maleki N, Aghabalaei Danesh M. Evaluation of the serum zinc level in adult patients with melasma: Is there a relationship with serum zinc deficiency and melasma? J Cosmet Dermatol. 2018 Jun;17(3):417-422.
Handog EB, Galang DA, Leon-Godinez D, et al. A randomized, double-blind, placebo-controlled trial of oral procyanidin with vitamins A, C, E for melasma among Filipino women. Int J Dermatol 2009; 48: 896–901.
About Francis Wu
‘In my dermatology practice I often come across people who suffer from itching. I see what they struggle with and unfortunately too often notice that certain care products help someone from bad to worse. Because I want you as a user to be able to rely on the product you are applying, I have developed my own skincare line: Iconic-Elements. A complete skin care line that stands out because it works (evidence-based)!