Melasma is a tan or dark skin facial discoloration that typically appears in women 20 to 50 years of age. An estimated 6 million women in the United States and 45 to 50 million women worldwide live with melasma. Additionally, women with olive or darker skin have a higher incidence of melasma. Although the exact cause of melasma is unknown, it is most often associated with sun exposure, taking birth control pills, and pregnancy.
Although melasma may cause cosmetic concerns, it does not pose a serious health risk. For those cases in which the trigger of melasma is known (for example pregnancy or birth control pills), it can resolve itself over a period of several months once the trigger recedes. For more stubborn cases of melasma, topical creams that help to fade the discolored spots are recommended. With the appropriate treatment and care, your melasma can significantly diminish. Once the melasma disappears it is important to prevent further outbreaks by regularly wearing sunscreen.
The only symptom of melasma is the appearance of a symmetrical (appearing on both sides of the face) brown or gray brown discoloration on the face. This discoloration most often appears on the:
- Bridge of the nose
- Above the upper lip
Although less common, some may notice the appearance of melasma on their forearms or neck.
The primary cause of melasma is unknown. However, it is thought that melasma occurs when pigment producing cells (melanocytes) are stimulated by female sex hormones, estrogen and progesterone, to produce more melanin when exposed to the ultraviolet radiation of the sun. As such, situations that produce elevated levels of hormones may predispose a woman to melisma.
The following factors may increase your risk for developing melasma:
- Gender. Women are much more likely to have melasma. 90 percent of those living with melasma are women. Melasma is very uncommon in men. Only 10 percent of melasma cases are men.
- Ethnicity. People with olive or darker skin such as those of Latin/Hispanic, African, African-American, Asian, Indian, Middle Eastern and Mediterranean descent are more likely to get melasma.
- Pregnancy. Up to 75 percent of pregnant women develop some degree of melasma. During pregnancy, the condition is often referred to as chloasma, or "mask of pregnancy”. For most women, the dark patches may fade or completely disappear after they give birth.
- Taking birth control pills.
- Taking hormone replacement therapy.
- Excessive exposure to the sun. Ultraviolet (UV) light from the sun stimulates the melanocytes to produce more pigment. In fact, just a small amount of sun exposure can make melasma return after fading
- Cosmetics: Skin care products that irritate the skin may worsen melasma.
- Certain medication. Medications such as anti-seizure medications may make the skin more prone to pigmentation after exposure to ultraviolet (UV) light.
- Genetics. People who have a blood relative who had melasma are much more likely to get melasma.
Melasma is usually diagnosed by examining the facial discoloration. Dermatologists often utilize a Wood's light (a lamp that emits ultraviolet radiation in the range of 340 to 400 nanometers) to assist in assessing how deeply the melisma has penetrated the skin. In rare cases, a skin biopsy may be performed in order to rule out other causes of skin discoloration.
In some cases melasma may resolve on its own without any medical intervention. However, for persistent melasma the following treatments are available.
- Hydroquinone: This medicine is a common first line treatment for melasma. It is applied to the skin and works by lightening the discolored area. You can acquire hydroquinone over the counter, however these creams usually contain less hydroquinone than the product that is prescribed.
- Tretinoin and corticosteroids: To promote skin lightening, your dermatologist may prescribe tretinoin or a corticosteroid. Sometimes a medicine will contain all three active ingredients discussed (hydroquinone, tretinoin, and a corticosteroid) in 1 cream.
- Azelaic or kojic acid. Creams with these ingredients can also help to lighten the melasma.
If the above medications do not diminish your melasma, then the following alternative treatments may be recommended by your dermatologist:
- Chemical peel. This technique uses a chemical solution that causes dead skin to slough off and eventually peel.
- Microderm abrasion. This technique utilizes a machine to mechanically exfoliate the face, which removes the uppermost layer of dead skin cells.
The following can prevent your melasma from getting worse or the recurrence of melisma.
Wear sunscreen and a wide-brimmed hat every day. Since sunlight triggers melasma, dermatologists recommend wearing sunscreen daily. This is important because some of the sun’s UV rays can touch the skin — even through clouds and windows.
Choose a sunscreen that has the following three properties:
- Broad-spectrum protection (protects against UVA and UVB rays)
- A minimal sun protection factor (SPF) of 30.
- Zinc oxide to physically blot the sun’s rays.
- Use your medicine exactly as directed by your dermatologist.