Melasma and inflammation have a dysfunctional relationship. Inflammation is the bad boyfriend that keeps melanin hostage. He cannot help himself; his actions reflect the toxic environment he grew up in…

Clinical research delivered a lot of evidence that melasma and inflammation are holding hands:

• A 75 % increase of lymphocytes in melasma skin.
• Mast cell activation in women with melasma.
• VEGF is a cytokine found in melasma and responsible for the vascular component.
• Women with acne suffer 3 times more likely from post inflammatory hyperpigmentation if they have melasma, compared to women with acne but no melasma.
• SCF levels in melasma lesions are higher. SCF is a cytokine typically released by dermal stem cells (fibroblasts) and triggers melanin production. Meaning melanocytes respond to warnings from other damaged skin cells.
• Histamines send melanocytes into over drive and alter their appearance (enlarged and more dendritic—hallmarks in melasma)

The truth is that hyperpigmentation is an immune response by default. A tan is a response to the sun and disappears when sunlight becomes absent. When the brown spots don’t disappear; chronic inflammation could be the underlying issue.

What is inflammation?

Inflammation is a natural, healthy defence reaction of the immune system. Whenever stressors take your body out of balance, your immune system comes in, kicks the culprit out and repairs the damage.

When does inflammation become a problem?

When it becomes chronic and the repair phase is impaired.

Why does inflammation become chronic?

When stressors persist. Either the body cannot clear stressors or the stressors keep coming. This keeps the immune system in a constant fight or flight state.

What are the most common stressors that trigger melasma onset?

1. Sex hormone imbalances from the pill, pregnancies (also pregnancy losses), IUD’s, menopause, and cancer medications (tamoxifen).

The birth control pill is perhaps the most common trigger of melasma not related to pregnancy. The pill causes cellular chaos in the hormone production, nutrient sensing, drives inflammation and burdens the detox organ liver. Oh my. Not just meaningful regards melasma but acne too.

2. Emotional and mental stress.

An overload of stress hormones alerts the immune system as well. Melanocytes go into overproduction in the presence of cortisol’s precursor ACTH.

3. Skin damage from cosmetic treatments

I have heard countless times how laser and IPL triggered the first melasma breakout. SCF is a cytokine often found in melasma skin, although it is released by fibroblasts. When this dermal stem cell gets injured from laser and Co, it releases cytokines, which in turn activate melanocytes.

4. Skin damage from sunburns

UV light overkill is rare in modern days unless you work outdoors. But a hefty sunburn from a boozy lunch in the sun on the weekend or during a holiday in the Caribbeans can trigger chronic damage.

Also, windows and sunscreens split UVA and UVB rays. The unhindered penetration of UVA is a much bigger concern and than sun in its whole spectrum.

All of the above are stressors! They trigger an immune response, cause inflammation, and keep melanin stuck. Worth reducing, clearing, repairing or eliminating!

Below are more hidden contributers to chronic inflammation:

Pathogens, e.g. mold

The increased lymphocyte count is an indicator of that. Pathogens activate mast cells. Mold causes indoor air pollution—another inflammation trigger and link to melasma.

Inflammatory foods and food additives

They damage the gut lining and disturb the gut microbiome balance—one of your most important detox allies. I have seen people having flare-ups of their chronic skin issues just because they ate something with “natural flavouring”. Seemingly small things like that can ignite the fire. Always check the ingredient list of packaged food.

Household toxins

Think textile Dyes, toxins in carpets and mattresses, chemicals from cooking ware, toxins in skincare and make-up.

Artificial light overkill

Believe it or not but ambient night light in the bedroom causes systemic inflammation. Too much artificial light and not enough natural light signals the body: Something isn’t right. Inflammation is the consequence.

Heavy metals

Cause inflammation, create oxidative stress, and disturb bowel function.

Air pollution

VEGF, a cytokine found in melasma and the factor responsible for the increase in the blood vessels around pigmented lesions. Increased VEGF levels and an increase in blood vessels are a symptom of oxygen deprivation. SFC is another cytokine released when oxygen is low. Reasons can be poor air quality or weak breathing. Interestingly, melasma is more common in big cities with high air pollution.

Drugs and medication

Electromagnetic Frequencies (EMF)

Excessive Heat (working in environments with high heat)

Pesticides

Oxidative Stress

Caused when the body produces too much waste (from breaking down food and toxins) and doesn’t have enough antioxidants (poor mitochondrial function and lack of fresh produce). Oxidative stress is common in melasma and releases cytokines that keep melanin coming back.

Nutrient Deficiencies

Cause stress and as a result inflammation; chronic inflammation if not resolved.

Anything that causes a toxicity or a nutrient deficiency causes inflammation. When these toxicities or deficiencies aren’t addressed, inflammation persists, along with stubborn brown spots.

That is why I believe in detox and proper nutrient supply for skin health.

Some experts say detoxing is wrong when a person’s well-being is compromised and that it puts more strain on the body. The truth is, the body cannot heal when it is inflamed. If toxins are the reason for inflammation, then the only way out is through detox.

The thing that sparked the interest to look into this connection and eventually combine everything to a book was the increasing number of women with melasma that came to me as an esthetician. 22 years ago, when I started working in my profession, I have rarely seen melasma. Perhaps a few times yearly in a pregnant woman. When I started looking into the research in 2020, I had 3 women come to me weekly, and hardly anyone had it from pregnancy.

Combing through the research and connecting the dots, it became more obvious how environmental changes from modern life are the reason for the surge.

Other melasma experts and holistic practitioners report their clients have success by reducing inflammatory foods, especially the histamine-rich type. While this makes totally sense and is a silver lining, there are still women who can’t seem to shake melasma off regardless. The rise of women suffering melasma in the past 20 years tells me: It ain’t histamine-rich foods alone. I am also guessing, Westerners eat less histamine rich foods (fermented foods for example) in a standard diet compared to the previous century.

It is unfortunate that gut loving foods like sauerkraut, kefir and kombucha have to take a backseat, to keep the immune system calm.

Although I admit histamine in food leftovers, and restaurant meals that aren’t freshly cooked are problematic too.

I truly believe the underlying issue is toxins locked away in the body. The body tends to dump them in fat cells because it prefers to deal with more pressing tasks. Cells are like buckets and when that bucket spills over with waste, a little bit of histamine from otherwise beneficial food sends the body into a battlefield.

Sadly, we often neglect detoxification and some people consider detox as unnecessary or even dangerous.

I totally understand if that is all overwhelming and feels dark or hopeless. However, many examples show that reversing melasma is possible and the healing process is a lot more simple than the complex root-cause map suggests.

Lifestyle changes can be hard at first but overtime become second nature. Be warned, healing your body holistically and naturally might be the hardest thing you have ever done. Detox is not a bandage solution. Your symptoms aren’t managed or curbed. You bring forth a metamorphosis. If you ever watched a butterfly making its way out of a cocoon, It looks like a struggle and a painful process. Transformation is hard.

What to do about this?

The first step is identifying the stressors and toxins in your daily life. Slowly eliminate them.

If you want to be sure about the toxic load in your body, find a practitioner who can test your blood, urine, hair and poop for environmental toxins, heavy metals and pathogens.

Active Detox

Finnish sauna

This one sounds crazy because heat exacerbates hyperpigmentation. But please hear me out. The increased darkening is only temporary. Heat increases the oxygen supply to the skin via increased blood circulation, and because oxygen is a crucial component in melanin formation, it can deepen the colour. However, saunas are a very effective way to expel toxins and free melanin. It has a long tradition passed down by our ancestors. That is why I specifically say Finnish sauna. I worked with women who followed the advice, went regularly to the sauna, and their melasma got better, not worse.

I feel reluctant about red light sauna. Not because I have negative experiences with it, but simply because I don't trust new technologies as blindly anymore. A personal choice and opinion I don’t want to impose on you. Please always do your own research regarding red light saunas.

Exercising

Movement is medicine. It moves the lymph and increases the blood circulation. Exercising til you sweat releases even more toxins. But be gentle to yourself and don’t push if you are stressed. Allow enough post-exercise repair.

Fasting

Fasting is a very effective cellular clean out and reset. After at least 17h of fasting, the body goes into autophagy and disposes damaged proteins, DNA and other waste products.

This can be the wrong approach if you are already stressed according to some experts. If you have melasma and through the roof cortisol or ACTH (adrenal fatigue), then fasting is secondary after you have healed your hormonal imbalance.

I personally observed a monthly window where fasting feels easier, which is after my period and before ovulation. Menstruating and ovulating requires extra energy and is not the right time for a fast.

Clinoptilolite

Clinoptilolite is a type of zeolite, which is a naturally occurring mineral sourced from sediment. Originally used for water purification. The molecules resemble little cages, whose structure enables them to scoop up toxins without confusing them with essential nutrients. I don’t believe in zeolite sprays but in drinking a suspension of powder in spring water as part of a daily cleanse.

Making a paste from zeolite with a splash of water makes a fantastic detox face mask and you can even make your own toothpaste from it.

Microbiome Recovery

Probiotics are health promoting bacteria and your invisible cleaning troop. They do a lot of the heavy lifting in metabolizing food and therefore reduce oxidative stress and inflammation. Eating a variety of locally sourced food, one fermented food a day, and breathing different environments helps them thriving.

Overall, the skin, lymph system, kidneys, bowels, and liver are your detox organs. Giving them love and keeping them clean maintains your built-in renewal system.

I hope this helped? Let’s talk about this and tell me your opinion.

If you would like to read more about the root causes of melasma, please check out my book The Truth About Melasma (includes 250 references to evidence about the vast map of chronic hyperpigmentation).

This information is for educational purposes only. Written by a trained cosmetic scientist and holistic esthetician who went down deep rabbit holes. No medical advice, just a collection of scientific facts and conclusions based on them. It would be arrogant to speak in absolute terms about reversing melasma. We are still learning so much about skin conditions. I am also aware this is a sensitive topic, especially if you are affected in the flesh. If your melasma is stubborn, a cleanse is an option to consider.