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All over the world, millions of people suffer from one form of pigmentary disorder or the other. Among them, the most prevalent are melasma and post-inflammatory hyperpigmentation. In general, melasma is common, with statistics ranging 9% to 50% in high-risk groups. The condition is more often seen in East Asian populations [1].
Melasma manifests as brown to grey-brown patches on the face, mostly on areas like the forehead, nose bridge, cheeks, chin, and above the upper lip. The problem is seen more in women than in men. Although primarily genetic and hormonal, prolonged exposure to high temperatures and harsh sunlight is the other major contributing factor to this pigmentary disorder [2].
When it comes to protection against sun damage, most people know sunblock as a product designed to block harmful rays from penetrating the skin. But is sunblock enough to keep melasma at bay? Will it really prevent hyperpigmentation from spreading further?
In this article, we find out if sunblock is the solution to this stubborn skin condition.  
How Sunblock Works
In a nutshell, skincare products that protect against the damage caused by sun exposure are known as sunblock. Depending upon the basic mechanism used to block UV rays, sunblock can broadly be categorised as a physical sunscreen and a chemical sunscreen.     
PHYSICAL SUNBLOCK | CHEMICAL SUNBLOCK |
|---|---|
Ingredient Base: Contains mineral actives such as zinc oxide and/or titanium oxide | Ingredient Base: Contains chemical actives that are organic, carbon-based compounds. Some of the commonly used ingredients include avobenzone, octisalate, and oxybenzone |
Sunblock Mechanism: Acts as a barrier to block and deflect harmful UV rays from the skin surface | Sunblock Mechanism: Acts as an absorber for the UV rays and subsequently transforms it into heat which the skin thereafter discharges easily |
Action Mode: When applied to the skin, it acts as a physical barrier against harsh sunlight and UV rays | Action Mode: When applied to the surface, the skin easily absorbs the sunblock |
Sunblock protects the skin against sun damage and in that sense reduces the amount of melanin produced by the body to prevent any further darkening of the skin. The first step to melasma prevention is understanding how exactly sunlight triggers the condition.  
How Sunlight Triggers Melasma
Melanin is a pigment found in the human body that is responsible for giving the skin, hair, and eyes their distinctive color. Hyperpigmentation occurs when melanin levels rise due to excess production of melanin. Most commonly, sun exposure, hormonal fluctuations, and aging trigger the increased production of melanin in the body.  
Melanin is essentially a product of the body’s defence mechanism against sunlight and to reduce the damage by UV radiation. Prolonged exposure to harsh sunlight leads to your body producing more melanin, which can cause hyperpigmentation.  
 Oxidative stress caused by the sun’s UVA and UVB rays is the primary cause of premature skin aging and hyperpigmentation, but recent studies have shown that high-energy visible light, the light we see all around us, also causes oxidative stress to skin and can also contribute to hyperpigmentation [3]. But is sunblock alone sufficient to protect against melasma?      
Sunblock is Your Basic Defence
Due to the very high chances of a relapse, melasma has the infamous reputation of being a stubborn skin disorder [4]. Classified as a chronic disorder, effective melasma treatment involves controlling the condition from returning or getting more severe. But while sunblock won’t get rid of it, it will help prevent it from exacerbating the problem.  
 The UVA rays are a stimulant for melanin to develop on the skin. Since these harmful rays can penetrate even window glass, you remain at risk of exposure to UVA rays even when you’re staying indoors during the daytime. For this reason, a broad-spectrum sunblock having SPF30 and above is considered ideal protection against UVA rays and further photodamage. 
Melasma: A Relentless Struggle
Unfortunately, while sunblock is the ideal first line of defense against photodamage, it is not sufficient to protect the skin from melasma completely. This is because melasma conditions vary from person to person. Much of the sun damage occurs below the age of 20. For some, the pigmentation is superficial and stain the outermost layer of skin or epidermis.
In others, the issue runs deeper and affects the dermis. Most often, cases where both layers get affected, making it even more difficult to treat melasma. Regardless of how much sunblock you pile onto the skin, eventually, nature will regain the upper hand.
That said, it doesn’t mean that nothing can be done to treat melasma.
Treatments for Melasma
Due to the complexity of melasma as well as its stubborn nature, targeting it with a four-pronged approach offers an optimistic treatment outcomes. Ensoul Medical Clinic’s melasma therapy program synergises the healing properties of medical lasers, energy-based devices, and topical products.    
1) Pigment Removal
This phase of treatment helps speed up the elimination of the destroyed pigments with the help of a variety of lasers. For instance, the long-pulsed ND:YAG laser splits the pigment sediments into much smaller particles that the body can naturally flush out easily and much faster. Similarly, the fractional Erbium YAG laser helps in the speedy removal of pigments by increasing the rate of skin cell turnover. Thereafter, a larger number of destroyed pigments get flushed out along with these skin cells.
2) Reduction of Transfer
This phase comprises the use of lasers to decrease the movement of pigments from the cells to the skin. A selection of specifically curated pigmentation lasers helps to break down pigment particles very efficiently. The laser devices also counter the melanin overproduction that is induced by the skin’s exposure to high-intensity sunlight. (The low-fluence treatments, penetrates deep into the dermis while the epidermis remains almost intact.
The photoacoustic mechanism of these lasers not only destroys the pigment, sparing the surrounding keratinocytes and melanocytes [5]. The laser also curtails the dendritic process which in turn decreases the number of pigments that are transferred to the skin cells.
Nd: YAG Laser, and pico lasers or picosecond Alexandrite lasers are some of the lasers commonly used in the treatment to help control melasma and reduce pigmentation levels.
3) Control of Hypervascularity
This part of the treatment focuses on regulating hypervascularity or the profusion of blood vessels below the skin surface – a condition commonly associated with melasma. Using yellow lasers, vascular endothelial growth (VEGF) secretion is decreased. This reduces abnormal blood vessels under the skin are reduced, effectively controlling pigmentation production.
The inclusion of yellow laser in melasma treatment helps stimulation of pigmentation cells and also reduces the chances of relapsing [6].  
4) Reduction of Production
In patients with stubborn melasma, chronic melanin production is targeted with a combination of laser therapy and medications. Topical skincare products can help reduce pigmentation levels. When over the counter (OTC) products do not work, medical-grade products are needed. The most commonly prescribed topicals are for disrupting the enzymatic processes that produce pigment within the melanocytes [7].
Compared to OTC creams and lotions, medical-grade products such as hydroquinone are more effective in tackling hyperpigmentation. In OTC products, pigment production is only slowed down with the use of ingredients like Retinol, Alpha Arbutin, or other traditional ingredients. The topical products contain gentle peels that help speed up the skin cells' renewal, thus slowing melanin production. As it does not help to speed up the removal, this treatment works very slow and only on superficial pigmentation.
Our Solution for Melasma
A wide range of lasers are used in melasma treatments because the underlying problems are not fully solved by just reducing the excess pigmentation. In effect, no single laser treatment offers effective treatment for melasma. That’s why, at Ensoul Medical Clinic you’ll find that each and every treatment program is specially curated to individual patient conditions and expectations.
With its curated combination of laser devices, the Quad Laser Program is fully equipped for treating pigmentation issues at the dermal and epidermal layers. The program stands out for its holistic approach to promoting skin health and quality. However, some melasma patients may also require additional therapy with pulsed RF microneedling or other energy device-based treatments [8].       
Conclusion
With multiple factors at play, the treatment of melasma is certainly a complex and challenging task. Adequate and prolonged photoprotection is therefore paramount to prevent exacerbating the problem. Sunblock has been shown to be the first line of defence to prevent melasma improve the severity of the problem and reduce relapses [9].
That said, melasma is a pigmentary disorder that sits deep within the dermis and epidermis of the skin and sunblock alone is not sufficient to get to the root of the problem. For a holistic treatment for melasma, speak to our doctor to find out which treatment is suitable for you.