What is melasma?
Melasma is a skin condition that causes brown or greyish blotchy patches that appear on the face. It occurs when the melanocytes in the skin produce increased amounts of the skin pigment, melanin. The pigment is deposited in the skin, causing an uneven complexion.
While it does not cause any other symptoms, the visibility of the lesions can negatively impact one’s self-esteem and quality of life.
What causes melasma?
So what makes melanocytes act up? There’s no straight answer, but it’s often a combination of genetics, hormonal fluctuations, and sun exposure.
Brown-skinned people or those who tan easily appear to have a higher predilection for this condition. About 60% of patients report that they have at least one relative who also has blotches on the face, underlining a hereditary component.
Roughly 90% of melasma patients are women. Imbalances in female sex hormones are likely to play a role. Melasma is also referred to as “the mask of pregnancy” because it can occur in pregnant women, particularly those in the latter half of gestation. The condition has also been associated with the use of hormonal contraception.
Chronic, unprotected sun and light exposure are important factors in the development of melasma. UV radiation has long been known to cause irregularities in normal skin cell processes. These bump up melanocyte numbers, melanin production, and melanin transfer. In addition, it inhibits lipid synthesis, causes oxidative stress, and increases blood vessel growth. More recently, more attention has also been given to the fact that visible light, not just UV, also contributes to melasma and hyperpigmentation. That means that your monitor screen, TV and mobile devices may also be contributing to melasma.
How to treat melasma?
The appearance of melasma can be improved with agents that inhibit melanocyte activity and protect against triggering factors. Dermatologists will recommend strict sun protection and often recommend a combination of active treatments yielding quicker and more noticeable results than monotherapy (ie treatment with one agent).
The first medication that doctors reach out for when a melasma patient walks in is hydroquinone. This is applied topically, and can be found in formulations that also include tretinoin and corticosteroids. Other agents include azelaic acid, kojic acid, licorice extract, ascorbic acid and glutathione.
Tranexamic acid is the only oral medication that is prescribed to help improve melasma patches, but studies on glutathione and Polypodium leucotomos are also showing promise. Tranexamic acid can also be used topically in creams.
To prevent further darkening and boost the effectiveness of any treatments, it is crucial to wear sunscreen and practice sun-smart behavior, always. Sunscreens used for melasma should be tinted and contain iron oxide pigments. These pigments not only block UV to some degree, but also block visible light, which as we mentioned, also plays a role in melasma formation.
Your dermatologist may also recommend procedures such as chemical peels or laser treatments. Both procedures remove the melanin deposited on the surface of the skin in different ways. However, tread with caution as these might backfire and lead to post-inflammatory hyperpigmentation when not done right. Make sure to have these procedures done at a reputable dermatology clinic.
It is important to set expectations on the outcome of treatment. It can take months to years to see significant improvement, especially if the melanin is deposited in the deeper layer of the skin. It also needs to be appreciated that melasma is a chronic condition. This means that it will come back and flare unless it is always managed in one way or the other. Understanding melasma is the first step in managing this condition well and for the long-term.
Purpose of this information
The information presented on this website and in this article is for general information and example purposes only, does not contain health advice specific for users and must not be relied on for that purpose. Please see your GP, dermatologist or other health care professional for specific advice.
References:
https://www.aad.org/public/diseases/a-z/melasma-treatment
https://dermnetnz.org/topics/melasma/
Ogbechie-Godec, O. A., & Elbuluk, N. (2017). Melasma: an Up-to-Date Comprehensive Review. Dermatology and therapy, 7(3), 305–318. https://doi.org/10.1007/s13555-017-0194-1
Sarkar, R., Arora, P., Garg, V. K., Sonthalia, S., & Gokhale, N. (2014). Melasma update. Indian dermatology online journal, 5(4), 426–435. https://doi.org/10.4103/2229-5178.142484
