Melasma is a common skin condition in which dark brownish patches develop on your skin. It’s also called chloasma, or the “mask of pregnancy,” when it occurs in pregnant women. The condition is much more common in women than men, though men can get it too. According to the American Academy of Dermatology, 90% of people who develop melasma are women.
What happens in melasma?
Melasma causes patches of discolouration which are darker than your usual skin colour. It typically occurs on the face and the most common areas include:
- The bridge of the nose
- The forehead
- The cheeks
- The upper lip
Melasma may also appear on other areas of the body, especially those exposed to a lot of sunlight like the forearms, neck or even shoulders. Although the skin discolouration doesn’t do any internal harm, one may feel self-conscious about the way it looks.
If you notice such symptoms, consult a dermatologist, a doctor who specializes in treating skin disorders.
A glance in the mirror may still show some darkened patches on your skin that seem to be sticking around despite using over the counter products. These brown blotches, typically on the forehead, chin, cheeks, upper lip, or nose, may signal a condition called melasma. It’s not only associated with pregnancy but can affect women in all stages of life. And it may last for many years.
Dr. Siddhartha Saikia
Who gets melasma?
Melasma is more common in women than in men. It typically begins between the ages of 20 and 40 years. It is also more common in people who tan easily or have naturally brown skin. It is less common in people with very fair skin or black skin.
Causes and risk factors of melasma
It isn’t totally clear what causes melasma. And while melasma isn’t painful and doesn’t present any health risks, it can cause significant social and emotional distress. The condition can be difficult to treat, and there’s a lot of misinformation out there about what causes it.
Melasma appears when the melanocytes (pigment-producing cells in the skin) become hyperactive and produce too much pigment in certain areas of the skin. The mechanism is somewhat similar to what causes brown age spots and freckles, but melasma patches tend to be larger.
Melasma has a lot of different causes. Two in particular stand out:
Hormones (including hormonal medications): Fluctuations in certain hormones can cause melasma, which is why it commonly occurs during pregnancy. It may also occur when you either start or stop hormonal contraception, including birth control pills, or when you take hormone replacement therapy.
Sun exposure: The sun is the big culprit in triggering melasma. Underlying factors such as hormonal changes may not manifest until a person goes on vacation to a western location like Goa, or during the summertime when she spends more time in the sun. The sun is the major exacerbating factor, whatever the underlying cause. Melasma can be caused or worsened by not only the sun’s rays but also heat and visible light.
Other factors implicated in the development of melasma include:
- Genetics: 60% of people report affected family members
- Thyroid disorder can be associated with melasma
- Medications: Certain medicines may cause melasma.
- Scented products: Perfumed soaps, toiletries, and cosmetics may cause a phototoxic reaction to trigger melasma.
How is melasma diagnosed?
For a skin specialist, a visual examination of the affected area is often enough to diagnose the condition. To rule out specific causes, your healthcare professional might also perform some tests.
One testing technique is a Wood’s lamp examination. This is a special kind of light that’s held up to your skin which allows your healthcare professional to check and determine how many layers of skin the melasma affects. To check for any serious skin conditions, they might also perform a biopsy but it is usually not performed these days because other non-invasive modalities such as dermatoscopy are available.
Is melasma treatable?
For some women, melasma disappears on its own. This typically occurs when it’s caused by pregnancy or birth control pills.
There are creams your healthcare professional can prescribe that can lighten the skin. If these don’t work, chemical peels, dermabrasion, and microdermabrasion are possible options. These treatments strip away the top layers of skin and may help lighten dark patches.
These procedures don’t guarantee that melasma won’t come back, and in some cases, the pigmentation can’t be completely lightened. You might have to return for follow-up visits and stick to certain skin treatment practices to reduce the risk of the relapse. These include minimizing your sun exposure and wearing sunscreen daily.
Treating melasma
The first step in treatment is confirming with a dermatologist that your darkened skin patches are indeed melasma, and determining what’s causing it. Treating melasma is unlikely to be effective if the underlying cause isn’t addressed.
At Saikia Skin Care (Gandhinagar), we take a thorough medical history to find out what’s causing the melasma. Then adjustments are made. If a hormonal contraceptive is causing the problem, a woman might consider switching to a non-hormonal option, such as a copper intrauterine device.
Beware dangerous skin-lightening scams
Sometimes women who are desperate to improve the appearance of melasma will seek out treatments online. Hyperpigmentation problems have become a huge moneymaking industry. But many of these products are at best ineffective and at worst, unsafe. These include oral or injected glutathione products, which can cause potentially dangerous thyroid and kidney problems. It’s important to verify the safety and efficacy of any treatment with a certified dermatologist or your skin doctor. Also, keep in mind that the FDA has not approved any injectable products for skin lightening or whitening.
Avoiding Sun Exposure
The next step in treating melasma is to prevent the sun from aggravating the condition. This may require extreme diligence and regular sunscreen application. To know more about sunscreens, check out All About Sunscreen.
The sun is stronger than any medicine I can give you. The most important way to clear up melasma is by using a strict sunscreen regimen. But keep in mind that not all sunscreens are created equal. To prevent melasma, you need a sunscreen that blocks not only the sun’s rays but also its light and heat.
Dr. Siddhartha Saikia
There are two main types of sunscreens:
- Sunscreens that use chemicals, such as oxybenzone
- Sunscreens that use physical blockers, such as zinc and titanium dioxide.
You want to choose the non-chemical, blocking sunscreen, because that will stop all the light and different wavelengths from coming through. Chemical sunscreens don’t offer the same protection for melasma, and in some instances, they may even trigger allergic reactions that can make the condition worse.
It is a good idea to wear a hat that can provide sun protection if you’re going to be outside for an extended period of time.
At-home treatments
There’s more you can do on your own to help your skin heal and prevent future damage. In addition to reducing sun exposure, try these steps:
Establish a good cleansing regimen. Environmental pollution can contribute to melasma. Airborne pollutants can bind to the skin and corrode the protective surface, making it weaker and more susceptible to sun damage. Clean your skin every night before bed with a cleanser that can thoroughly remove particulate matter and help protect the skin.
Combat skin stress with antioxidants. Vitamins C and E can help heal damage from sunlight. So, dab on a few drops of a serum that contains these vitamins to improve skin health and ward off the harmful effects of sun exposure.
Moisturize your skin regularly. Use a good moisturizer after the serum to restore the lipid (fat) barrier of the skin, which helps to protect it from damage.
Be patient. Even with treatment, it may take months for the pigmentation to clear up. There’s no overnight fix.
Be diligent. Melasma will be quick to return if you’re not careful about sun protection. So, long-term maintenance requires an ongoing commitment to protecting your skin.
Topical Therapy
- Hydroquinone: This medicine is a common first treatment for melasma. It is applied to the skin and works by lightening the skin. Higher concentrations of hydroquinone can cause white spots to develop on the skin and may even cause a darkening of the skin in some cases so consult a certified dermatologist before you start it.
- Tretinoin and corticosteroids: To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains three medicines (hydroquinone, tretinoin, and a corticosteroid) in one cream. This is called a triple cream.
- Other topical (applied to the skin) medicines: You may be prescribed other alternatives to help lighten the pigmentation. Many other agents are under investigation.
If you notice any of the following after getting treatment for melasma, be sure to call your dermatologist:
- Skin irritation
- Darkening of the skin
- Other problems
Medical procedures
If topical medications do not work, a dermatologist may recommend procedures such as:
- Microdermabrasion
- Chemical peel
- Laser treatment
- Light therapy
- Dermabrasion
Superficial epidermal pigment can be peeled off using alpha-hydroxy acids (AHA), such as glycolic acid, or beta-hydroxy acids (BHA), such as salicylic acid.
Microneedling, intense pulsed light (IPL), and lasers including Q-switched Nd:YAG, ablative and non-ablative fractionated and picosecond lasers carry a high risk for relapse and the disease becoming more resistant to treatment, so require expert use.
New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type. For example, peels can work for some people. “And for some people, it makes it worse. It’s very hard to predict. Ask your dermatologist about possible side effects (health problems that can result from the treatment).
Oral treatment
Tranexamic acid blocks conversion of plasminogen to plasmin, with downstream effects inhibiting the synthesis of prostaglandin and other factors involved in melasma. More new oral treatments are being researched.
What is the outcome for melasma?
Melasma can be frustrating to treat. It is slow to respond to treatment, especially if it has been present for a long time. Even in those who get a good result from treatment, pigmentation may reappear on exposure to summer sun. The chronicity and risk for relapse with the need for lifelong sun protection should be emphasised to set realistic goals and outcomes.
Under a dermatologist’s care, many people with pigmentation have a good outcome. Melasma can be stubborn, though and it may take a few months of treatment to see improvement. It is important to follow your dermatologist’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects.
After your melasma clears, you may need to keep treating your skin. This is known as maintenance therapy. Maintenance therapy can prevent melasma from returning.