Melasma is a common skin condition which appears as brown to gray-brown patches on the face, usually the cheeks, bridge of the nose, forehead, chin, and above the upper lip. It can appear on other parts of the body which are exposed to sun frequently or for long periods of time, such as the forearms and the neck.
One of the most common treatments for melasma is sun protection – using a sunscreen every day and reapplying it every two hours when outdoors. Cosmetic dermatologists advise wearing a broad-brimmed hat as well; sunscreen alone may not provide enough protection.
More than 90 percent of the people affected by melasma are female. It’s so common in pregnancy that it has even been called the “mask of pregnancy.” Hormones, particularly estrogens, seem to trigger melasma.
Who is affected?
People with naturally darker skin are more prone to get melasma, including people of Latin/Hispanic, North African, African-American, Asian, Indian, Middle-Eastern and Mediterranean descent. In families in which some members are known to have the condition, other family members are more likely to be affected by it as well.
Causes of Melasma
What causes melasma is not entirely clear. According to the American Academy of Dermatology (AAD), it is probable that the pigment-producing cells in the skin, called melanocytes produce too much pigment. People of color are more prone to melasma – their melanocytes are more active than those of people with lighter skin.
Common melasma triggers include:
- Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. Even a small amount of exposure can cause melasma to reappear after it has faded with treatment. Melasma is more common and more apparent during the summer. Sun exposure is why many people have a recurrence or many recurrences of melasma.
- Changes in hormones: Melasma is very common in pregnancy, in which it is then called chloasma, or the mask of pregnancy. Birth control pills and hormone replacement medications can also trigger the condition.
- Cosmetics: Skin care products that irritate the skin may stimulate the skin’s melanocytes and produce melasma.
- Heat: Heat has been shown to worsen melasma. Many chefs or people who tend to be surrounding by heat tend to have difficult to treat melasma. This is why a broad-spectrum sunscreen is important for treatment, including infrared, or heat, protection.
Signs and symptoms
Melasma does not cause symptoms – meaning that it doesn’t affect the individual’s sensation or physical perceptions. It can and does, though, cause distress and emotional disturbance by its appearance.
Signs include brown or gray-brown patches on the face. These patches commonly appear on the:
- Cheeks
- Forehead
- Bridge of the nose
- Above the upper lip
- Chin
It is not common, but some people get the patches on their forearms or neck.
Diagnosis
Cosmetic dermatologists can diagnose melasma by just looking at the skin. A Wood’s light is a device that a cosmetic dermatologist may shine on the skin to see how deeply the melasma penetrates the skin.
Rarely, melasma can look like another skin condition. To definitively determine the diagnosis, your cosmetic dermatologist may need to remove a small piece of skin for examination under magnification. The procedure is called a biopsy, and is usually performed safely and quickly in the physician’ office.
Treatment
Melasma may fade without treatment, when the condition which triggered the melasma is reversed, such as pregnancy or the use of oral contraceptives. The condition may improve when the baby is delivered or birth control pills are discontinued.
For some people, melasma remains for years, even a lifetime. There is no role for laser treatment. Melasma treatments are available, including:
- Sunscreen: This is the most important treatment for sunscreen. A broad spectrum sunscreen, including both UVA and UVB protection, and ideally infrared protection, is recommended. Sunscreen must be reapplied every two hours, even though the patient is not going to the beach or outside much. Talk to your dermatologist about the best sunscreen choice for you.
- Hydroquinone: This is a common initial treatment for melasma. The medication, for topical (surface of the skin) application, is formulated as a gel, lotion, or cream, which works by lightening the skin. Some of these are available over-the-counter without a prescription, but there are products that your cosmetic dermatologist can prescribe which contain a greater concentration of hydroquinone.
- Tretinoin and corticosteroids: Either of these medications may be recommended for use with hydroxyquinone. There are products which contain all three medications: hydroquinone, tretinoin, and a corticosteroid. It may be called a triple cream.
- Other topical medications: Your cosmetic dermatologist may prescribe azelaic acid or kojic acid to enhance lightening of the melasma patches.
- Procedures: If topical medications do not achieve sufficient results, a procedure may be more effective. These can include a light chemical peel, dermabrasion, or microdermabrasion. The less inflammation to the skin the better.
Side effects
Some side effects which can occur with any of these medications and/or procedures include skin irritation, darkening of the skin, and others. Call your cosmetic dermatologist if you experience discomfort or side effects.
Results
Melasma is persistent. Your best chance for success is to have the care of a cosmetic dermatologist, following her instructions exactly. Still, it may take months to see improvement. The dermatologist will make sure that you receive the maximum benefit from treatment, with minimal side effects. After you have achieved the best results possible, the physician may advise you to keep treating your skin. Such treatment is called maintenance therapy; it can help prevent melasma from recurring. Use a sunscreen (broad-spectrum), reapply, and when outside, a broad/brimmed hat to limit the possibility of a recurrence.
Melasma Reference
The American Academy of Dermatology: https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/m—p/melasma/diagnosis-treatment
