Melasma in Ayurveda (Vyanga): what peels and Ayurvedic treatment can and cannot do

Melasma is a patch of light to dark brown, sometimes grey-brown, skin on the cheeks, forehead, bridge of the nose, upper lip or chin. It usually appears on both sides of the face, and it does not itch or hurt. It is far more common in women, usually from the twenties to the forties, and common in Indian skin.

The usual triggers are:

• Sunlight, including the visible light that comes through windows
• Hormonal change: pregnancy, when it is called the mask of pregnancy, and hormonal pills
• A family tendency
• Heat, and irritation from strong products

It is easy to confuse with other marks. Tan covers all the skin the sun reaches and fades faster. Acne marks sit where pimples were. Freckles are small separate dots. A single dark spot that is growing or changing is a different matter, and should be examined before any cosmetic treatment.

The Sushruta Samhita lists Vyanga among the minor diseases of the skin. In its account, vata roused by anger and exertion joins with pitta, reaches the face, and leaves a thin, painless, dusky patch.

Two practical points follow from that description:

• The cause is partly within. Treatment works on pitta and on the blood, not only on the surface: internal medicine, and for some people a cleanse such as Virechan or Raktamokshan, which the doctor decides on after an examination.
• Stress, heat and late nights are part of the picture. The diet advice is to cut down sour, salty, fermented, fried and very spicy food and alcohol, all of which raise pitta.

Classical face applications for Vyanga use herbs such as manjishtha, red sandalwood and saffron. Bought products vary widely, so ask before you put one on melasma.

• Sunscreen, every day. Without it, nothing else lasts. Use it indoors as well, since window light counts.
• Creams. These are chosen for your skin and used for months, not weeks.
• Chemical peels. The clinic uses fruit, glycolic, lactic, Nomelan and yellow peels, chosen after looking at your skin, as a course of six sittings. A series of gentle peels is safer than one strong one, because Indian skin marks easily after irritation. See chemical peels.
• Skin polishing brightens the surface and helps tan, but it does not remove deep pigmentation.
• A carbon facial freshens oily, dull skin. It does not remove melasma.

Aggressive treatments that heat or injure the skin can make melasma darker. That is the main reason gentle treatment, repeated over time, is preferred.

Creams that contain a steroid are often sold as fairness creams or used for melasma without a prescription. They lighten the skin quickly at first. With time they thin it, bring redness, acne-like spots and visible fine vessels, and when they are stopped the melasma returns darker than before.

Lemon juice, household bleach and harsh scrubs do harm in a similar way: they irritate the skin, and irritated Indian skin answers with more pigment.

Melasma fades over weeks to months, more slowly than tan, and it tends to come back with sun or hormonal change. Melasma that began in pregnancy may fade after the baby is born, though often not completely. Keeping it away is part of the treatment, which means sunscreen and an occasional maintenance sitting after the patches have cleared.