What is Melasma?
Melasma is a skin condition characterized by the development of the brownish patch on the skin of the face. It is also known as chloasma or the mask of pregnancy which occurs during pregnancy. It is a common skin condition that is usually seen on the forehead, bridge of the nose, cheek, the upper lip and chin. Melasma can also occur in the areas of the skin that are in constant exposure to the sun such as in the neck and forearm.
Melasma can affect many people regardless of racial group although it is more commonly seen among groups that have darker skin tone especially Asians. It is more common in women than in men and usually arises at the age of reproductive years. It is seldom during or before the puberty stage. Melasma is also common during pregnancy in which it is termed as chloasma or the mask of pregnancy.
Melasma is the consequence of the overproduction of the melanin produced by the melanocytes. It is generally a harmless skin condition and is non-life threatening. Melasma on the other hand can cause embarrassment due to the area of its development. It can affect not only pregnant women but can also affect normal and healthy individuals. The incidence of melasma is often associated with exposure to the sun and pregnancy. It is a skin condition that does not cause any discomfort but can lead to psychological stress as a result of the unappealing skin patches. Melasma on the other hand has various treatment options available to help those in distress as brought by the unsightly effect of melasma.
Melasma is neither a contagious skin condition, nor it is potential for skin malignancy. It is not also the consequence of an infection or allergy. This skin condition is more prominent during the hot summer months and improves or becomes less noticeable during the winter season.
Melasma generally does not cause any discomfort but can be distressing and embarrassing due to its clinical appearance which can affect the cosmetic aspect of the patient. It usually appears in the most obvious area of the skin particularly in the centrofacial, cheekbone and the jaw line.
The incidence of melasma is marked by the appearance of dark or brownish pigment on the areas of the skin that are often exposed. The macular hyperpigmentation often in tan to brownish hue are distributed in three main patterns that made this skin condition distinct from any other types of skin problems.
The three main patterns of distribution in Melasma include the following:
- Centrofacial pattern which basically appears on the forehead, cheekbones, nose and the upper lips
- Malar pattern generally appears on the cheeks
- Mandibular pattern is melasma appearing in the jawline
The clinical appearance of melasma is a skin patch with darker than usual skin tone and distributed in a symmetrical pattern. The borders of the skin patches are somewhat irregular and the patches usually develop in a gradual manner.
Melasma has different types which are classified according to the depth of pigmentation. This is basically identified through the use of a Wood lamp.
The different types of Melasma include the following:
- Epidermal is the melasma type recognized by the existence of excessive melanin found at the superficial layer of the skin. It has a dark brown pigmentation with well defined borders and is visible under the black light. This type of melasma often responds well to treatment.
- Dermal is the most common type of melasma. It is made distinct by the existence of melanophages found in the entire dermis. The skin patch is usually in light brown to bluish color with ill defined borders. It remains unchanged when exposed under the blacklight and it usually responds poorly to treatment.
- Mixed type of melasma is the combination of both the epidermal and dermal types. The colors of the skin patches are combinations of bluish, light and dark brown. The patterns of the borders are the mixture of both the epidermal and dermal borders while the response to treatment is limited.
Melasma is the consequence of an overproduction in the melanin when the melanocytes are stimulated by the estrogen and progesterone hormones. However, the exact etiology of melasma remains unclear but is being linked to the genetic condition that predisposes an individual with a family history of melasma. The incidence of melasma however, is rather complex and with several factors considered to trigger the incidence.
Several factors are being considered to trigger the onset of melasma and such factors include the following:
- Exposure to the sun is the most implicated factor in melasma. Melasma is believed to be potential in prolonged exposure under the sun especially in those genetically predisposed individuals
- Pregnancy is one common factor believed to influence the onset of melasma. The incidence however tends to fade after delivery
- Genetic predisposition plays an important factor in influencing the development of melasma
- Hormone treatments such as oral contraceptive pills and hormone replacement therapy are believed to contribute to the incidence of melasma although not all women undergoing hormone treatments will suffer from melasma
- Thyroid disease is believed to be a contributory factor in the development of melasma
- Allergic reaction to medications and cosmetics
Treating melasma is rather complex as the exact cause is unknown. It usually responds gradually to treatment while it spontaneously fades after delivery in melasma associated with pregnancy. No exact cure has been identified for melasma although there are several options available which may help in improving the appearance of melasma.
The treatment options for melasma include the following:
Sunscreen is among the first line of treatment in melasma. Putting on broad spectrum sunscreen is beneficial in improving the appearance of melasma.
Hydroquinone application in topical cream or lotion of 2% to 4% is the most used for improving the appearance of melasma. It is a depigmenting agent that acts by lessening the overproduction of melanin.
Azelaic acid is an effective alternative for treating melasma especially in pregnant women as this is found to be safe. Azelaic acid comes in cream or lotion or gel and may be used for long term although the medication may give a slight stinging when applied.
Epidermal type of melasma can be improved through peeling of the skin. This method of treatment allows the tyrinase inhibitors to effectively go through the skin. This method of treating melasma can be achieved with the use of topical retinoid, salicylic acid and topical alpha hydroxy acids.
Whatever the treatment method, it is especially recommended to protect the skin from the sunlight which is greatly implicated in melasma. It is beneficial to put on sunscreen before heading under the sun and to stay away from the sunlight if necessary or when there is no need to stay under the sun for too long.