Melasma (sometimes known as chloasma) is a condition that affects the skin, leaving brown patches commonly around the upper lip, forehead, and cheekbones. It can also form on the sides of the neck, nose chin, and lower cheeks. There are usually distinct edges around the dark patches.
Melasma most commonly affects young women who are using birth control pills and frequently affects women during pregnancy. It can also develop during menopause, with ovarian disorders and hormonal imbalances. Another trigger for melasma is the medication Dilantin (phenytoin).
In some cases, melasma can develop without any of the aforementioned factors, and one in ten cases affects men. The best way to prevent melasma and treat it is through sun avoidance/protection and using skin lightening products.
How does one develop melasma?
The likelihood of developing melasma is dictated by genetics. It is not currently understood how the genetic factors contribute to melasma, but it is quite clear that people who have an inherited baseline skin color between the ranges of light olive to very dark olive are more likely to contract melasma.
Melasma is sometimes referred to as the mask of pregnancy since it tends to affect pregnant women. Since oral contraceptives and pregnancy are factors that can contribute to melasma, it is believed that estrogen is the catalyst that causes melasma to surface in predisposed individuals.
This hypothesis is unlikely to be true, however, since men are also affected, albeit rarely. A common factor that does seem to be present in all individuals affected by melasma is that they were exposed to sunlight. Both ultraviolet A and B (UVA and UVB) are speculated to be a main contributor of melasma in predisposed individuals.
How does melasma affect an individual?
The dark spots of melasma may be present in one or two layers of one’s skin. The pigment may be present in only the surface layer of skin, known as the epidermis. Alternatively, it may solely be present in the inner layer of skin, known as the dermis.
Commonly, however, the pigmentation is present in various degrees in both outer layers of skin. The existence of pigmentation on both the dermis and epidermis has interesting implications when it comes to melasma treatment.
Since melasma is developed as a result of factors such as genetics, hormones, and the sun, it is hypothesized that in order to prevent melasma, the combination of these factors need to be altered. Since it is not currently possible to alter one’s genetic predisposition towards melasma, and generally not practical to alter hormonal influences, the last remaining factor is sun exposure.
How to treat melasma?
As a result, the primary preventative method for melasma is total sun protection involving the use of sun protective hats and clothing, use of broad-spectrum sunscreens, and avoidance of the sun within reasonable expectation.
Similarly, melasma treatment is based upon the same principle of sun protection, and in addition, the use of products designed to reduce pigmentation within the surface skin layer. Dermatologists generally recommend wearing sunscreen each morning, hydroquinone containing skin bleaches at night or twice daily, and vitamin A products at night as tolerated for individuals suffering from melasma.
Following this regimen will generally provide positive results within only two months, and the best results within six months. These products are easy to get a hold of since they are all available over-the-counter. However, more potent bleaches and vitamin A derivatives can only be purchased with a prescription.
Dermatologists may also endorse the use of chemical peeling using glycolic or tri-chloro-acetic (TCA) acid on a case-by-case basis to accelerate improvement of melasma. Microdermabrasion is a process that has also been found to be beneficial in the treatment of melasma, especially if used in conjunction with topical products.
Regardless of the treatment method, results are not always consistent. This variation is due to where the melasma-related pigmentation is found within the skin of the affected individual. Surface pigmentation is the easiest to remove using conventional treatments but deeper pigmentation is unaffected by surface treatment.
Fortunately, deeper pigmentation will slowly disappear on its own so long as there is consistent total sun protection. Individuals with only surface level pigmentation will see much more rapid results than those whose pigmentation are primarily deeper. Even just one day of negligence in regards to sun exposure can undo months of melasma treatment, especially in individuals who are prone to deeper pigmentation.