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Melasma – Causes, Symptoms and Treatment

Melasma is an acquired skin pigmentation disorder characterized by symmetrical, brownish patches on the face. It most commonly affects women with darker skin tones.

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Things worth knowing about "Melasma"

Melasma is an acquired skin pigmentation disorder characterized by symmetrical, brownish patches on the face. It most commonly affects women with darker skin tones.

What is Melasma?

Melasma (also known as chloasma) is a common, benign hyperpigmentation condition of the skin. It presents as irregular, light brown to dark grayish-brown patches that typically appear on the face – most often on the cheeks, forehead, nose, upper lip, and chin. The condition predominantly affects women, especially those with medium to darker skin tones (Fitzpatrick skin types III–VI), and most commonly occurs during the reproductive years.

Causes

The exact causes of melasma are multifactorial. Key contributing factors include:

UV radiation: Sun exposure is the most significant trigger. Ultraviolet rays stimulate melanocytes (pigment-producing cells), leading to excessive melanin production.
Hormonal changes: Pregnancy (which is why melasma is sometimes called the mask of pregnancy), hormonal contraceptives, and hormone replacement therapy can trigger or worsen melasma.
Genetic predisposition: A family history of melasma increases the risk of developing the condition.
Cosmetics and medications: Certain skincare products and phototoxic medications may contribute to its development.
Thyroid disorders: An association between melasma and thyroid dysfunction has been reported.

Symptoms

Melasma is characterized by the following clinical features:

Symmetrical, irregular hyperpigmented patches on the face (cheeks, forehead, nose, upper lip, chin)
Color ranging from light brown to dark grayish-brown
Well-defined or poorly-defined flat patches with no raised texture
No pain, itching, or other physical discomfort
Seasonal variation: worsening in summer due to sun exposure, fading in winter

In rare cases, the forearms or neck may also be affected. The psychological impact of the changed appearance can be significant for many patients.

Diagnosis

Melasma is typically diagnosed clinically by a dermatologist. The following methods are used:

Clinical examination: Assessment of the distribution and color of pigmented patches.
Wood lamp examination: A special ultraviolet lamp helps determine the depth of pigmentation (epidermal, dermal, or mixed type).
Dermatoscopy: Magnified examination of the skin lesions to help differentiate from other conditions.
Skin biopsy: Reserved for exceptional cases where other diagnoses such as lentigo maligna need to be excluded.

Treatment

Melasma can be treated, but it is often difficult to achieve permanent remission, as relapses following sun exposure are common. Treatment involves several approaches:

General Measures

Consistent sun protection (broad-spectrum sunscreen SPF 50+, hats, avoiding direct sun exposure) is the most important foundation of treatment.
Discontinuing hormonal contraceptives or hormone therapy where medically appropriate.

Topical Treatments

Hydroquinone: Considered the gold standard of topical depigmentation therapy; inhibits melanin synthesis. Long-term use should be monitored by a physician.
Tretinoin (retinoic acid): Promotes skin cell turnover and enhances the effect of hydroquinone.
Azelaic acid: A well-tolerated agent that inhibits melanin production.
Kojic acid and Vitamin C: Natural compounds with depigmenting properties.
Tranexamic acid: Recent studies show promising results both topically and systemically.

Dermatological Procedures

Chemical peels (e.g., glycolic acid, trichloroacetic acid)
Laser treatments (e.g., fractional laser, Q-switched laser) – used with caution, as they can sometimes worsen melasma
Microdermabrasion

Prognosis

Melasma is often a chronic condition prone to relapse. With consistent sun protection and appropriate treatment, significant improvement is possible. In hormonally triggered melasma (e.g., during pregnancy), spontaneous resolution may occur once the triggering factor is removed.

References

Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatology and Therapy. 2017;7(3):305–318. doi:10.1007/s13555-017-0194-1
Passeron T, Picardo M. Melasma, a photoaging disorder. Pigment Cell & Melanoma Research. 2018;31(4):461–465.
American Academy of Dermatology Association (AAD). Melasma: Diagnosis and Treatment. Available at: www.aad.org. Accessed 2024.

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