What is Melasma?
Melasma is a usual skin issue that leads to the formation of brown to gray-brown spots on the face. These spots are often found on the cheeks, chin, bridge of the nose, forehead, and above the upper lip. It’s more frequently seen in women than in men. Pregnancy often triggers melasma. It’s also prevalent among women who are on birth control pills or taking hormone treatments.
What Causes Melasma?
Melasma is a skin condition where dark, discolored patches appear on the skin. Several factors can cause melasma, including genetics, sunlight, certain medications, hormones, and thyroid disease.
Some people are genetically more likely to get melasma. This condition is more common in women than men. People with light-brown skin living in sunny areas are especially prone to melasma. Around half the people with melasma have a family member who also has it. Even identical twins can both get melasma.
Exposure to sunlight is another big factor. UV-light from the sun can cause damage to the cells in our skin, which can lead to more melanin production. Melanin is the pigment that gives our skin its color. The more melanin produced, the darker the skin becomes. Sunscreens might not always help because even though they block some of the damaging UV-light, they don’t block all the types of light that stimulate melanin production.
Hormones, like estrogen and progesterone, can also play a role in the development of melasma. This is especially relevant during pregnancy, as hormone levels increase during the third trimester. This could explain why some pregnant women develop dark patches on their faces, known as the “mask of pregnancy.” Even in non-pregnant women with melasma, we often find higher than normal levels of estrogen receptors within the discolored patches.
Thyroid disease is another factor linked to melasma. People with melasma are four times more likely to have a thyroid condition. We also see a connection between melasma and certain types of moles that have increased pigmentation. This indicates a link between melasma and other conditions that cause changes in skin color.
Risk Factors and Frequency for Melasma
Melasma, a skin condition, can affect individuals of all races. However, it is usually more prevalent in people with darker skin, especially those of light brown complexion. This condition particularly affects women, as they are nine times more likely to have it than men. Melasma rarely occurs before puberty, but is more common during the reproductive years. It is seen in 15% to 50% of pregnant women. The prevalence of Melasma can range from 1.5% to 33% in different population groups.
Signs and Symptoms of Melasma
Melasma is a type of skin discoloration that typically appears on areas of the skin exposed to the sun. It presents as dark, often symmetrical, spots. These spots can be either joined together or appear as separate tiny dots. It’s most noticeable, and usually worse, on the parts of the skin that receive a lot of sun exposure. These areas include the cheeks, upper lip, chin, and forehead.
Testing for Melasma
There’s usually no need for lab tests if you’re dealing with melasma, which is a condition where brown patches appear on the skin. However, some studies have shown that minor issues with the thyroid can be connected with melasma, especially in pregnancy or in those who are on birth control pills. If these situations apply to you, your doctor might consider evaluating your thyroid function. A special kind of examination, called a Wood lamp examination, can help doctors identify whether the skin pigment changes are happening on the surface of the skin (epidermis) or deeper down (dermis).
Treatment Options for Melasma
If you have melasma, which is a common skin problem causing brown patches usually on the face, it’s advisable to avoid direct sunlight, discontinue high-SPF sunscreens (50 or higher), and avoid estrogen exposure if possible. In terms of medication, a topical combo of hydroquinone cream is often the first choice. Hydroquinone works to lighten the skin, and there may also be some other ingredients like tretinoin, which helps the skin to renew itself, and fluocinolone acetonide, a type of steroid that reduces inflammation and itchiness. If you can’t use creams with these elements or have an allergic reaction to them, there are alternatives available with fewer ingredients.
If these creams aren’t working, or a quicker result is needed, there are options like chemical skin peels or laser treatments, but these have mixed results. They can sometimes have adverse side effects like skin damage, darkened skin spots (hyperpigmentation), and raised scars. These methods shouldn’t be the first option – they’re meant to be used only if creams haven’t been effective.
Skin peels involve apply chemicals like glycolic acid or salicylic acid to the skin, which can help to speed up the replacement of the darkened skin cells with new ones. This is usually done on a weekly or monthly basis, starting with a low-concentration formula and gradually working up to higher concentrations if necessary. Skin peels are often more effective when used alongside skin-lightening products, and they should only be used after you’ve already tried at least one skin-lightening cream. Constantly monitoring of the skin during treatment is crucial, and treatment should be stopped if the surrounding skin begins to lighten too.
A laser treatment option should be considered only in severe and resistant-to-treatment cases thinking about the fact that this might worsen the skin condition. It’s important to remember that these treatments can occasionally lead to less-than-desirable cosmetic results.
What else can Melasma be?
When considering what might be causing your skin symptoms, doctors consider the following possibilities:
- Actinic Lichen Planus
- Acanthosis Nigricans
- Discoid Lupus Erythematosus
- Drug-Induced Photosensitivity
- Exogenous Ochronosis
- Frictional Melanosis
- Mastocytosis
- Nevi of Ito and Ota
- Pigmented Contact Dermatitis
- Poikiloderma of Civatte
- Postinflammatory Hyperpigmentation
What to expect with Melasma
Melasma, a skin condition that causes dark, discolored patches on the skin, doesn’t put you at risk of dying or becoming sick. Additionally, there are no reported cases of it transforming into a dangerous condition like skin cancer. In fact, people with melasma are thought to have a smaller risk of getting melanoma, a type of skin cancer.
In regards to treatment, the deeper skin pigment (the dermal pigment) may take longer to fade than the surface skin pigment (the epidermal pigment). This is because there’s currently no treatment that can effectively remove this deeper pigment. However, this does not mean treatment should not be given if most of the pigment is at this deeper level. This is because the source of the deeper pigment is actually the surface skin and if the production of pigment in the surface skin can be stopped for a long time, the deeper pigment will eventually fade out.
However, it’s important to know that melasma can be stubborn. It often reoccurs and it is guaranteed to come back if strict measures to avoid sunlight are not taken.
