What is melasma and how is it diagnosed?
Melasma is a common skin condition or pigmentation disorder, that is characterized by brown or gray patches of skin. Melasma typically occurs on the face, with the most common spots being the cheeks, upper lips, forehead and bridge of the nose. It may also occur on certain areas of the skin that are frequently exposed to sunlight, such as the shoulder, neck and forearms. Dermatologists can visually diagnose Melasma through a physical examination, and a biopsy of the skin is often not necessary. Melasma is not known to cause pain or discomfort, but the patches of skin can be visually bothersome to some.
Who gets Melasma?
Melasma often occurs in individuals between 20-40 years of age and ethnic groups with darker or tannish skin; such as Middle Easterners, Indians, Hispanics, Pacific Islanders and those of African origin. Melasma is a type of hyperpigmentation of the skin that occurs most commonly in females. Of patients with Melasma, males yield 10% while women yield 90% of the cases.
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The condition is not restricted but typically limited to the areas on the face; such as the cheeks, forehead, chin and above the lip. In the female population, the condition commonly arises during women’s reproductive years and rarely during puberty. Melasma is also seen in males but is less common due to genetics and less hormonal changes which influence melanin production.
What is happening in the skin during melasma production?
The skin is made of 3 layers, epidermis, dermis and subcutaneous, from outermost layer to inner. The skin contains cells called melanocytes, which are responsible for producing melanin (aka the pigmentation or color of the skin). In response to light, sun exposure, ultraviolet radiation and hormonal stimulation, the melanocytes produce more melanin causing the skin to darken and even create undesirable dark patches on areas, such as the face.
What are the causes?
Genetics: Genetics play a role as women have a significantly higher tendency to get Melasma than men. In addition, most commonly the condition is seen in individuals who are genetically predispositioned to darker skin types. Individuals who are fairer-skinned are less likely to be affected by melasma because individuals with darker skin tones have more active melanocytes. Lastly, approximately 50% of individuals with Melasma have family history of the condition and cases have been reported in identical twins.
Prolonged sun exposure: UV radiation stimulates melanocytes to produce more melanin. Individuals who have Melasma have detected their condition to be worse in the summer and better in the winter season.
Pregnancy: Melasma is often referred to as the “mask of pregnancy”. This is related to the fluctuating estrogen and progesterone levels which activate the production of melanin. Up to 50% of pregnant women get this condition and it often fades away after pregnancy. It is important to note that Melasma can also present in response to taking oral contraceptives or any other hormonal treatment.
What are the treatment options?
There are several ways to treat melasma. The most common treatment is hydroquinone, which is a depigmenting agent. Hydroquinone 2% may be purchased over-the-counter or hydroquinone 4% may be prescribed by a dermatologist.It can come in gel, cream or lotion form.
Another topical treatment option is tretinoin, a topical retinoid. Your dermatologist may prescribe a more potent lightening cream, known as Tri-Luma, which contains tretinoin 0.05%, hydroquinone 4% and fluocinolone 0.01%.
If topical medications fail, other medical procedures, such as chemical peels, light therapy and laser treatment, may be sought. These medical procedures do carry more risk than topical medications, so it is recommended you speak with your dermatologist before receiving treatment. Although there are treatment options, melasma can resolve by itself, if due to hormonal imbalances. Since ultraviolet light plays a key role in developing melasma, it can be prevented by avoiding peak sun hours, using sunscreen and wearing clothing that will limit sun exposure.
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