Melasma (Chloasma)

What is Melasma?

Melasma, also called as Chloasma faciei or the mask of pregnancy, is a tan or discoloration of the skin.

In other words, melasma can be defined as patchy brown or dark brown skin discoloration. The patches can occur on sun exposed body parts but mainly seen on the face.

In the condition of melasma, some portion of skin becomes darker than its surrounding areas. Health practitioners also term this as hyperpigmentation. On the face, it is commonly found on cheeks, upper lip and on the forehead.

Melasma is more commonly found in women than in men. It is also linked with hormonal changes that occur during pregnancy and therefore, dark patches are usual in pregnant women. If a woman is taking HRT (Hormone Replacement Therapy) or contraceptive pills, melasma is likely to occur.

There is a difference between melasma and chloasma. The dark patches during pregnancy are known as a mask of pregnancy or chloasma. They remain on the body until the pregnancy lasts.

Causes of Melasma

• Melasma is very common skin ailment. It can occur to anyone, but young women with brownish tone are more likely to contract with it.
• The condition is often linked with female hormonal changes. Change in level of estrogen and progesterone may cause melasma.
• Sun exposure is another potential factor that can cause melasma. Those who live in tropical climates are more prone to have melasma.
• Oral contraceptive or hormone replacement therapy can trigger dark patches on the skin.
• Genetic predisposition may give rise to darkening of the skin
• In patients diagnosed with thyroid are also prone to have melasma.
• Overproduction of MSH (melanocyte-stimulating hormone) due to stress can trigger darkening of the skin and cause melasma.
• Allergic reaction due to medicines or cosmetic products, in rare cases, induces melasma.
• In Addison’s disease (especially due to pressure or minor injury to the skin), melasma is observed as one of the symptoms.

How Does Melasma Occur?

The dark patches are thought to be produced as a result of stimulation of pigment-making cells (called as melanocytes) mainly due to female sex hormones (estrogen and progesterone). Excessive production of melanin results in darkening of the skin.

Individuals with a known history of melasma running in family (genetic predisposition) are more likely to contract the dark patches on the skin in the form of melasma. Such fellows should avoid going out in the sunlight and apply extra sunblock to protect the skin from the harmful rays. This is because individuals with a genetic predisposition have sensitive cells that easily get stimulated and produce hyperpigmentation.

How Melasma is Diagnosed

Melasma should be differentially diagnosed with post-inflammatory hyperpigmentation and actinic lichen planus, which are quite similar conditions.

The diagnosis of melasma is done with the help of a Wood’s lamp (340-400 nm wavelength). The affected area is carefully studied with excess melanin in the epidermis.

Melasma Symptoms

Melasma shows no other symptoms than darkening of the skin. The patient is presented with a dark skin patch on cheeks, forehead, upper lip or nose. In some rare cases, melasma is found on the neck and forearms. It does not do any physical harm, but cosmetically, the sufferers may worry as it may make the face ugly.

Treatment of Melasma

For women with good luck, melasma may be vanished with its own. The chances of this incidence are more in case of pregnancy or birth control pills as cause of melasma. In others, topical application (creams with 2% hydroquinone) can be prescribed that help lighten the skin. If this does not work, further treatment with dermabrasion, microdermabrasion and chemical peel can be thought of. Nevertheless, surgical procedure does not guarantee of its non-recurrence of the dark patches in future.

In any melasma case, the patient is advised to protect herself from the direct sunlight. Sunscreen lotions (SPF of 30 or above) and avoiding out in the sunlight is followed as a regimen.

In advanced cases of melasma, creams with a high concentration of HQ (hydroquinone) or HQ with other ingredients’ combination (such as glycolic acid, tretinoin or corticosteroids) is used. However, before using any over-the-counter medicine, one should contact a dermatologist.

You may ask the dermatologist some cosmetic product to cover up the patches on the skin. Products with white or yellow undertone will help fade the patches.

1. Azelaic acid (20%) is used to control the activity of melanocytes
2. Galvanic or ultrasound facial along with topical cream may help fading the dark skin patches.
3. Intense pulsed light (Fraxel laser or laser phototherapy) is used in case of dermal malesma, which is stubborn and difficult to treat.
4. Cosmetic camouflage helps to hide the dark patches on the skin.

How much time it takes to normalize the skin tone?

Melasma ends as soon as pregnancy ends. The dark patches start fading as the pregnancy approaches its end. In the other case, stopping hormone replacement therapy works as best remedy to cure melasma. In the normal case of melasma (the condition without any complication), it takes a few months to heal. However, discoloration does not go totally.

How to Prevent Melasma

The best way to prevent melasma is avoiding direct contact of sun rays onto the skin. If you have to go out in the sunlight, take precautionary measures mentioned below:-

1. Prefer hat over cap that prevents direct sunlight falling on your face as well as neck
2. Applying sunscreen lotion (titanium dioxide or zinc oxide) to areas exposed to the sun help preventing melasma to occur
3. Sunblock products help protect the skin from ultra-violate A and B radiation. You should choose the cosmetic with SPF (Sun Protecting Factor) of 30 or more.

Melasma Pictures

Picture 1: Melasma before and after

Picture 2 : Melasma on cheeks

Picture 3 : Melasma on forehead photo

Picture 4 : Melasma on face

Picture 5 : Melasma Image

References

1. www.medicinenet.com/melasma/article.html
2. http://www.aad.org/skin-conditions/dermatology-a-to-z/melasma/tips/melasma-tips-for-managing
3. http://health.nytimes.com/health/guides/disease/melasma/overview.html
4. http://www.drugs.com/health-guide/melasma-chloasma.html
5. http://www.nlm.nih.gov/medlineplus/ency/article/000836.htm