Melasma is a skin condition presenting as brown patches on the face of adults. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.
WHO IS AT RISK OF DEVELOPING MELASMA?
Typically Melasma occurs in women. Only 10% of those affected are men. Darker-skinned races, such as Hispanics, Indians, Asians, people of Middle Eastern decent, and Northern African, are more prone to developing melasma than those with lighter skin tones.
WHAT CAUSES MELASMA?
The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop the condition. A change in hormonal status can trigger melasma. It is commonly associated with pregnancy and called chloasma, or the "mask of pregnancy.” Birth control pills can also cause melasma, but hormone replacement therapy used after menopause has not been linked to developing the condition.
Sun exposure is known to contribute to melasma. Ultraviolet (UV) light rays from the sun can stimulate the melanocytes (pigment-producing cells) in the skin. Melanocytes produce a large amount of pigment under normal conditions, but when stimulated by light exposure or an increase in hormone levels this production increases even further. Incidental exposure to the sun is mainly the reason for recurrences of melasma. People with skin of color have more active melanocytes than those with fair skin.
Any irritation of the skin can cause increased pigmentation in dark-skinned individuals, which may also worsen their melasma. This condition is not associated with any organ malfunction or internal diseases.
HOW IS MELASMA TREATED?
While there is no cure for melasma, many treatments have been developed. Melasma can disappear after child birth; while in other cases it can remain for years, or even a lifetime.
The use of sunscreens is essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. A SPF 30 or higher should be selected (look for ingredients such as Mexoryl & Parsol-1789). Physical sunblock lotions such as titanium oxide and zinc oxide can be used to block both visible light and ultraviolet radiation. Sunscreens must be worn every day, even if it is not sunny outside. During simple daily activities such as driving, walking down the sidewalk or even sitting by the window exposes your skin to a significant amount of ultraviolet rays.
Any creams, make-up, or facial cleansers that cause skin irritation should be discontinued, as this may aggravate your melasma. If melasma develops after you have begun taking birth control pills, it may improve once you stop taking them. For patients who wish to continue taking birth control pills, their Melasma can be treated with bleaching creams.
There is a number of bleaching creams available for the treatment of melasma. These creams do not "bleach" the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells. Non-prescription creams contain hydroquinone in low concentrations; this is the most commonly used depigmenting agent. This treatment is often effective for mild forms of melasma when used twice daily. A dermatologist can prescribe creams that have higher concentrations of hydroquinone. Typically, it takes approximately three months before you will see substantial improvement in your melasma.
Creams containing steroids, tretinoin (Vitamin A acid), and glycolic acid are available in combination with hydroquinone to enhance the depigmenting effect. Other topical medications that have been found to improve melasma include: vitamin C, azelaic acid, and kojic acid. It is important to follow the directions of your dermatologist carefully in order to get the maximum benefit from your treatment regimen and to avoid irritation and other side effects. Remember, a high quality sunscreen with high SPF needs to be applied and reapplied periodically throughout the day in addition to the use of a bleaching cream. Many bleaching creams contain sunscreen (e.g. Lustra-AF, Glyquin-XM).
Microdermabrasion, chemical peels, and occasionally lasers can help melasma. These procedures have the potential of causing irritation, which can sometimes worsen melasma and so they should only be used in conjunction with a proper regimen of prescription creams and bleaching creams that are tailored to your individual skin type. These treatments should be performed under the supervision of your dermatologist. People should be cautioned against non-physicians treating melasma without the supervision of a doctor because complications can occur.
Managing melasma requires a comprehensive approach by your dermatologist. Avoidance of sun and irritants, use of sunscreens, applying depigmentation agents, along with your dermatologist’s close supervision can result in a successful outcome.
USEFUL WEBSITES ABOUT SKIN DISEASES
We put academic qualifications, many years of combined experience, and training in a variety of special interest areas to work for your healthy, radiant skin. Our providers – Drs. Schachter, Hanna, Curtis, Abdulla, Pollack, and Taradash – welcome new patients for treatment at the Dermatology on Bloor practice on Park Road in Toronto. Our team is here to serve your needs