Melasma is a chronic pigmentation disorder characterized by brown or gray patches on the skin. The pigmentation primarily occurs on the face, mainly in the upper lips, bridge of the nose, cheeks, and forehead, and is common across the forearms, neck, and shoulders. Melasma is likely due to the malfunction of melanocytes, pigment cells found in the epidermis layer of the skin.
The following factors are known triggers of melasma:
- Sun exposure – heat and visible light can cause abnormal pigmentation. However, the application of a non-chemical, sunscreen consisting of zinc and titanium oxide can block the sun’s rays and clear melasma. Chemical sunscreens don’t offer the same protection and may instead trigger allergic reactions that can worsen the pigmentation. Also, limit sun exposure, wear a wide-brimmed hat to shield your face, and wear protective clothing.
- Pregnancy – melasma occurring during pregnancy is known as chloasma. Increasing levels of estrogen, progesterone, and MSH during the second and third trimester stimulate the production of melanin. Melasma affects 15% to 50% of pregnant patients, with prevalence varying based on the population. The pigmentation tends to fade away a few months after delivery, but for many, there is some remaining pigmentation.
- Hormone treatments – Starting or stopping hormonal treatments such as birth control pills or hormone replacement therapy can cause fluctuations in certain hormones that cause melasma.
- Certain medications – therapy medication for cancer, scented or deodorant soaps, toiletries, and cosmetics can cause a phototoxic reaction, which in turn may result in melasma.
- Genetics – there is a genetic predisposition to melasma. Individuals with light-brown skin types in regions with high sun exposure are more likely to develop melasma. Women are also affected nine times as much as men are.
Visual examination is generally not enough to diagnose Melasma. To rule out other skin conditions, a biopsy or the Wood’s lamp examination may be done. A Wood’s lamp is a small handheld device that uses a black light to detect irregularities in the skin.
Melasma can last for years or even for the rest of your life. While melasma is benign, has no morbidity, and does not cause any physical symptoms, affected women report lower self-esteem, poor body image, anxiety, and depression. The psychological effects of the disorder are an important reason we need effective and diverse treatment options. The first line of treatment is usually hydroquinone, available as a lotion, cream, or gel, and is applied directly to the discolored patches. Hydroquinone is available over the counter, but your dermatologist may prescribe a stronger cream. There are also corticosteroids and tretinoin that can lighten the patches. Sometimes dermatologists may prescribe combination creams consisting of hydroquinone, corticosteroids, and tretinoin to maximally improve your individual symptoms. For women looking to avoid pharmaceuticals, Vitamin C derivatives and other natural products can also help with skin pigmentation and can improve melasma, though less effectively than prescriptions.
There are medical procedures such as microdermabrasion, chemical peel, laser treatment, light therapy, dermabrasion. These options may have side effects — risks must be thoroughly discussed with your doctor or dermatologist.
As always, there are home remedies that you can consider in the meantime. This involves cleaning your skin every night before bed with cleanser, increasing your Vitamin C and E intake, and moisturizing regularly. This will go a long way in terms of protecting your skin, and you will certainly see improvements with Melasma over the span of a few months if you stay patient and consistent with the process.
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