Effectiveness of a Broad-Spectrum Sunscreen in the Prevention of Melasma in Asian Pregnant Women

doi:10.4236/jcdsa.2013.33A2002

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Journal of Cosmetics, Dermatological Sciences and Applications, 2013, 3, 4-7

Published Online November 2013 (http://www.scirp.org/journal/jcdsa)

http://dx.doi.org/10.4236/jcdsa.2013.33A2002

Open Access JCDSA

Effectiveness of a Broad-Spectrum Sunscreen in the

Prevention of Melasma in Asian Pregnant Women*

Sophie Seité1#, Seok Beom Park2

1La Roche-Posay Pharmaceutical Laboratories, Asnières, France; 2Leaders Clinic, Seoul, Korea.

Email: #[email protected]

Received August 9th, 2013; revised September 7th, 2013; accepted September 15th, 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Chloasma, or melasma, is a commonly acquired pigmentary disorder among Asian women. It may be considered as a

physiological change during pregnancy. The incidence in Asian women is higher than that in other ethnic groups but

further epidemiologic data are needed. There are very few studies related to the benefits of sunscreens to prevent this

dermatosis. The aim of this study was to assess the effectiveness of a broad-spectrum sunscreen in the prevention of

melasma in Korean pregnant women. We tested the effectiveness and tolerance of a sunscreen product (SPF 50+,

UVA-PF 30) during a 12-month clinical trial including 220 Korean parturients with skin type III and IV. 217 women

completed the study. Only 3 (1%) of the study population developed melasma, which was mild (MASI grade between

1.2 and 2.7). In addition, the clinical effectiveness of the evaluated sunscreen was judged “good to excellent” by the

majority of study participants and by the research dermatologists. The “excellent” tolerance of the sunscreen under

evaluation was confirmed “good” to “excellent” in 95% and 97% of cases. This study clearly demonstrates that this

broad-spectrum sunscreen is well tolerated and effective in the prevention of melasma in Korean pregnant women. Al-

though treatment remains elusive, prevention is possible.

Keywords: Broad-Spectrum; Sunscreen; Chloasma; Melasma; Pregnancy; Photoprotection; SPF; UVA-PF

1. Introduction

Melasma is a commonly acquired pigmentary disorder

among Asian women [1-4] and the associated psycho-

logical distress and altered quality of life [5,6] are of par-

ticular concern for most pregnant women. During preg-

nancy, melasma is not usually treated, aside from using

an effective sunscreen and avoiding photosensitizing

products or inappropriate skin care routines i.e. friction.

However, in the literature, there are very few studies re-

lated to the beneficial use of sunscreen to prevent this

dermatosis. Consequently, pregnant women with a high

risk of developing melasma (skin type IV to VI, with

family history or increased outdoor sun exposure) do not

use an effective and correctly applied photoprotection

during their pregnancy.

In 2007, a Moroccan study conducted with H. Lakhdar

et al. [7], demonstrated that the regular use of a broad-

spectrum sunscreen prevented the development of

melasma during pregnancy. During this study, 200 preg-

nant women applied a sunscreen with a Sun Protection

Factor (SPF) of 50+ and UVA-Protection Factor (UVA-

PF) evaluated with the persistent pigment darkening

method (PPD) of 28. At the end of the pregnancy, new

melasma occurrence was 2.7% as compared with 53%

previously noted by H. Lakhdar et al. in the general

population in 1999 [8]. Interestingly, during this study,

we also observed an improvement of pre-existing

melasma in 8 out of 12 women presenting with melasma

at the beginning of their pregnancy [7].

2. Materials and Methods

Two hundred and seventeen pregnant women were re-

cruited by the Leaders Clinic in collaboration with the

Kwak Gynecology clinic in Seoul which includes 12 gy-

necologists between October 2009 and July 2010. Each

participant’s skin type was classified based on the Fitz-

patrick’s classification of skin phototype [9] (Table 1)

*Conflict of interest statement: Sophie Seité is an employee of La Roche-

Posay Pharmaceutical Laboratories.

Funding: this study was supported by a grant from La Roche-Posay

Pharmaceutical Laboratories, France.

#Corresponding author.

Effectiveness of a Broad-Spectrum Sunscreen in the Prevention of Melasma in Asian Pregnant Women 5

Table 1. Patients demographics.

Criteria N of patients (%) (N = 217)

Age* (years) 27.3 ± 1.6

Fitzpatrick skin type:

III

36 (17%)

181 (83%)

First pregnancy 182 (84%)

Number of children:

28 (82%)

6 (18%)

Single foetus 217 (100%)

Melanin index at the inclusion*

Forehead 180 ± 69

Chin 183 ± 36

Right malar 134 ± 35

Left malar 136 ± 36

Melanin index at the end

of pregnancy*

Forehead 177 ± 37

Chin 193 ± 34

Right malar 147 ± 28

Left malar 150 ± 27

*Data are mean ± SD.

although it is perhaps not really relevant to UV-sensitiv-

ity within the Korean population [10,11]. Throughout the

pregnancy, they applied once daily, a broad-spectrum

sunscreen (Anthelios XL, La Roche-Posay) with a SPF

50+ and a UVA-PF 30. Sunscreens and particularly

Anthelios XL have been already used in pregnancy to

treat or prevent melasma, and adverse events have not

been reported [7]. At the inclusion and at the end of the

pregnancy, several criteria were assessed including Mela-

nin Index, MASI on the Forehead, Chin, Right and Left

Malar of each subject. Melanin index was evaluated with

a Mexameter (Courage-Khazaka). The mean values of 3

measurements were used. The Melasma Area and Sever-

ity Index (MASI) is calculated by first ranking the sever-

ity of melasma in terms of its darkness, homogeneity of

appearance and the percentage area of the face affected

and then using the formula: MASI = 0.3(DF + HF)AF +

0.3(DMR + HMR)AMR + 0.3(DML + HML)AML +

0.1(DC + HC)AC. Darkness is ranked from 0 to 4, ho-

mogeneity from 0 to 4, area from 0 to 6 and total MASI

from 0 to 48 [12,13].

Standardized photographs were also taken. Further-

more, during the pregnancy, one to 4 phone calls were

made in order to ensure sunscreen use. During the last

visit, tolerance and efficacy of the sunscreen were evalu-

ated by both the investigator and patient. The weight of

product used was recorded.

3. Results

The baseline characteristics of the 217 pregnant women

included in this study are shown in Table 1. Only 26% of

women had had a previous pregnancy but none presented

melasma at the inclusion visit. Average Melanin Index

obtained on non-pigmented area of the Forehead, Chin,

Right and Left Malar of each subject at the inclusion and

at the end of the pregnancy is also noted in Table 1.

We noticed that all the participants, like most Asian

women, used their hands for facial cleansing and have a

complex, perhaps aggressive cleansing and skincare rou-

tine (Table 2). Interestingly, most of them usually use

daily photoprotection, 87% compared to less than 15% in

a European country (France) for example. Korean

women are fairly sensitive about their appearance, espe-

cially fair skin and cosmetic use, and are accustomed to

using sunscreen.

As previously reported in the Moroccan study [7], tol-

erance of the sunscreen was judged “good” to “excellent”

in 95% and 97% of cases and its effectiveness “good” to

“excellent” in 92% and 95% of cases by the women and

the dermatologist respectively. Each parturient received 4

tubes of 50 ml of sunscreen for the study, and used in

average 3 tubes (170 ± 32 g) during the study i.e. 30 g of

product per month of pregnancy.

Nevertheless, only 3 women out of 217 developed

Melasma, which corresponded to 1% of the study popu-

lation compared to 2.7% we saw in the Moroccan study

[7], this confirms the efficacy of the photoprotection use

during this study. These 3 women developed a Malar

melasma of very mild severity i.e. with a MASI between

1.2 and 2.7 (Table 3). This low severity was confirmed

by the difference of Melanin Index measured on a

non-pigmented and a pigmented area of the left and right

malar zone of these 3 women at the end of pregnancy

(Table 3). It is important to note that no adverse effect

was reported for these 3 women who judged the toler-

ance of the sunscreen product “good” and used the same

amount of product as the other women (Table 3).

4. Discussion

Pregnancy is a period of hormonal change that encour-

ages chloasma appearance [8]. Because this hyperpig-

mentation is aggravated by sun exposure [14], during

pregnancy, it is necessary to prescribe external sunscreen

and also provide advice on the sunlight avoidance, heat,

irritation of facial skin by rubbing or scrubbing, using

photosensitising products, etc.

The effectiveness of the sunscreen preparation evalu-

ated during this study was based on the fact that after the

pregnancy (8th or 9th month), only 3 cases of very mild

Open Access JCDSA

Effectiveness of a Broad-Spectrum Sunscreen in the Prevention of Melasma in Asian Pregnant Women

Table 2. Facial cleansing and skincare routine.

Products N of patients (%) (N = 217)

Cleansing

Make-up remover 9 (4%)

Cleansing product

(foaming cream, gel, bar soap…) 215 (99%)

Lotion or cosmetic water 216 (100%)

Skincare

Essence/serum 207 (96%)

Milky lotion or fluid 215 (99%)

Cream (without photoprotection) 208 (96%)

Usual daily photoprotection 189 (87%)

Table 3. Characteristics of the 3 affected women.

No. 1 No. 2 No. 3

MASI 2.1 2.7 1.2

MASI forehead 0 0 0

MASI chin 0 0 0

MASI right malar 0.9 1.8 0.6

MASI left malar 1.2 0.9 0.6

Melanin index

Non-pigmented right malar 149 145 129

Pigmented right malar 155 176 144

%* +4% +21% +11%

Non-pigmented left malar 133 151 132

Pigmented left malar 178 154 175

%* +34% +2% +32%

Quantity of products used (g) 205 165 155

%* = (pigmented area value − non-pigmented area value)/non-pigmented

area value × 100.

grade melasma were noted out of the 217 parturients who

completed the study, corresponding to 1%. This occur-

rence is much lower than the 2.7% we saw in the Mo-

roccan study [7] or than that in usual conditions in the

same geographical area [4]. Even if there are no pub-

lished data on prevalence melasma in Korea, according

to data obtained in 2001 (unpublished data) dealing with

normal Korean female population, the prevalence rate of

the perinatal and premenopausal women with melasma

showed 38% and 23% respectively.

Nevertheless, this study was not a comparative study

and it is important to note that it was limited by the lack

of a control group without sunscreen usage.

The Statistical Yearbook of Korean National Survey in

2010 says that the average age of women giving their

first baby is 30.1 years. In this study, the average age of

group was younger (27 years) and more than 80% are

women having their first baby. These young pregnant

women may have a lower risk of developing melasma.

Furthermore, the gestation stage of study group is usually

earlier than late stage. The later the gestation stage is, the

more melasma cases would be recruited. All these may

explain the very low occurrence rate noticed in this

study.

Nevertheless, we would advise dermatologists and

gynecologists as well as general practitioners to recom-

mend a safe and effective broad-spectrum sunscreen,

associated with an appropriate skincare routine as part of

their pregnancy follow-up. This would avoid difficult

post-pregnancy treatment of melasma. The safety and

high-grade cosmetic properties of the sunscreen product

adapted to the Asian skincare routine to improve pa-

tients’ compliance are also important.

5. Acknowledgements

We thank Amy Whereat who provided editorial support,

Martine Fortuné, Guénaëlle Le Dantec and Bernard Gab-

ard for their administrative support and Stéphanie Ragot

for the statistical analysis. The Leaders Clinic Derma-

tologists and the Kwak Gynecology clinic team are also

gratefully acknowledged.

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