What is melasma?
Melasma is a common skin problem. It is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation
It causes brown to gray-brown patches, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck.
The exact cause is not known, but several factors contribute. These include pregnancy, hormonal drugs such as the contraceptive pill, and very occasionally medical conditions affecting hormone levels. Some cosmetics, especially those containing perfume, can bring on melasma. There is research to suggest that it can be triggered by stress. Sunshine and the use of sun-beds usually worsen any tendency to melasma.
Melasma presents as macules (freckle-like spots) and larger flat brown patches.These are found on both sides of the face and have an irregular border. There are several distinct patterns.
Centrofacial pattern: forehead, cheeks, nose and upper lips
Malar pattern: cheeks and nose
Lateral cheek pattern
Mandibular pattern: jawline
Reddened or inflamed forms of melasma (also called erythrosis pigmentosa faciei)
Poikiloderma of Civatte: reddened, photoaging changes seen on the sides of the neck, mostly affecting patients older than 50 years
Brachial type of melasma affecting shoulders and upper arms (also called acquired brachial cutaneous dyschromatosis).
Known triggers for melasma include:
Sun exposure and sun damage—this is the most important avoidable risk factor
Pregnancy—in affected women, the pigment often fades a few months after delivery
Hormone treatments—oral contraceptive pills containing oestrogen and/or progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women
Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries and cosmetics—these may cause a phototoxic reaction that triggers melasma, which may then persist long term
Hypothyroidism (low levels of circulating thyroid hormone)
One of the most common treatments for melasma is sun protection. This means wearing sunscreen every day and reapplying the sunscreen every 2 hours. Dermatologists also recommend wearing a wide-brimmed hat when you are outside. Sunscreen alone may not give you the protection you need.
Women are far more likely than men to get melasma. It is so common during pregnancy that melasma is sometimes called "the mask of pregnancy." Hormones seem to trigger melasma. People with darker skin, such as those of Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, or Mediterranean descent are more likely to get melasma. People who have a blood relative who had melasma also are much more likely to get melasma.
Melasma can run in families, suggesting an inherited tendency.
Melasma is usually easily recognised by the characteristics of the pigmentation and its distribution on the face. Occasionally, your dermatologist may suggest that a small sample of skin (numbed by local anaesthetic) is removed for examination under the microscope (a biopsy) in order to exclude other diagnoses.Melasma can fade on its own. This usually happens when a trigger, such as a pregnancy or birth control pills, causes the melasma. When a woman delivers her baby or stops taking the birth control pills, melasma can fade.
Some people, however, have melasma for years — or even a lifetime. If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available. These include:
Hydroquinone: This medicine is a common first treatment for melasma. It is applied to the skin and works by lightening the skin. You will find hydroquinone in medicine that comes as a cream, lotion, gel, or liquid. You can get some of these without a prescription. These products contain less hydroquinone than a product that your dermatologist can prescribe.
Tretinoin and corticosteroids: To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains 3 medicines (hydroquinone, tretinoin, and a corticosteroid) in 1 cream. This is often called a triple cream.
Other topical (applied to the skin) medicines: Doctors may prescribe azelaic acid or kojic acid to help lighten melasma.
Procedures: If medicine you apply to your skin does not get rid of your melasma, a procedure may succeed. Procedures for melasma include a chemical peel, microdermabrasion, dermabrasion, laser treatment, or a light-based procedure. Only a dermatologist should perform these procedures.
Results take time and the above measures are rarely completely successful.
Unfortunately, even in those that get a good result from treatment, pigmentation may reappear on exposure to summer sun and/or because of hormonal factors. New topical and oral agents are being studied and offer hope for effective treatments in the future.