Melasma
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Melasma is a common skin condition that causes brown to gray-brown patches, which usually appear on the face. The cheeks, bridge of nose, forehead, chin, and upper lip are places where melasma is likely to form. It also can develop on the forearms and neck. Most melasma occurs in women. Only 10 percent of those affected are men. People with darker skin tones, including those of Latin, Asian, Indian, Middle Eastern, Mediterranean, and North African descent, tend to have melasma more than others.
CAUSES
What causes melasma is still unknown. People with a family history of melasma are more likely to develop this skin condition.
Chloasma
Pregnancy, birth control pills, cosmetics, hormone therapy, phototoxic drugs (make the skin more susceptible to light damage), antiseizure medication, and sun exposure often trigger melasma. Melasma is so common during pregnancy that it is often called chloasma, or the "mask of pregnancy." Sun exposure can trigger melasma because the pigment-producing cells in the skin (melanocytes) are stimulated by ultraviolet (UV) light from the sun. People with skin of color have more active melanocytes than those with light skin, so they produce more pigment. This production increases when stimulated by light exposure or rising hormone levels. Just a small amount of sun exposure is the main reason melasma returns after fading.
Irritating the skin also may trigger melanocytes in dark-skinned people to produce more
pigment. This is why using a skin care product that irritates the skin may worsen melasma.
Melasma of forehead
DIAGNOSIS
Because melasma is common and causes characteristic brown patches on the face, dermatologists diagnose most patients by looking at their skin. Occasionally, a skin biopsy is necessary to confirm that the brown patches are melasma.
TREATMENT
Sometimes melasma fades on its own. This is especially true after a pregnancy or when a woman stops taking birth control pills. If the melasma does not gradually fade or a woman wants to continue taking birth control pills, melasma can be treated.
A variety of creams are available to treat melasma. An active ingredient in these creams may be hydroquinone, a commonly used skin-lightening agent. If you notice irritation or darkening of the skin with a skin-lightening cream, consult your dermatologist immediately.
A dermatologist may prescribe a cream with a higher concentration of hydroquinone. A dermatologist also may prescribe creams containing tretinoin, corticosteroids, or glycolic acid, which may be combined with hydroquinone to enhance the skin-lightening effect. Another active ingredient that is being used to treat other conditions but also can help fade melasma is azelaic acid. Kojic acid may also help fade melasma.
A chemical peel, microdermabrasion, or laser surgery also may be used to treat melasma.
These can be successful, but these procedures should be performed by a dermatologist. Complications can occur when the procedure is not tailored to the patient's skin type.
It may take several months to see substantial improvement. It is important to carefully follow your dermatologist's directions during this time to ensure maximum benefit from the treatment. This also will help avoid skin irritation and other side effects.
Melasma on cheek
SUNSCREEN PLAYS IMPORTANT ROLE IN MELASMA TREATMENT
Along with medication, a dermatologist will recommend daily sunscreen use. This is essential because even when it is cloudy outside, the sun's UV rays can penetrate the skin. Sunscreen also must be worn when most of the day will be spent indoors because even a brief walk, driving, or sitting next to a window can expose unprotected skin to enough sunlight to trigger melasma.
When selecting a sunscreen for everyday use, look for one that offers broad-spectrum protection (protects against UVA and UVB rays) and has a sun protection factor (SPF) of 30 or more. Two ingredients that physically block the sun's rays are zinc oxide and titanium oxide. These can be quite effective for protecting skin affected by melasma. Continuing to wear sunscreen every day after the melasma clears can prevent it from returning.
When treating melasma, it also is important not to use products that irritate the skin. Any cosmetics (facial cleanser, cream, makeup, etc.) that irritate the skin may worsen melasma.
As you can see, treating melasma often requires a comprehensive and professional approach. Being under the care of a dermatologist helps many people achieve a successful outcome.
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A dermatologist is a physician who specializes in treating the medical, surgical and cosmetic conditions of the skin, hair and nails. To learn more about melasma log onto www.aad.org or call toll free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
1 (888) 462-DERM
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2009 American Academy of Dermatology
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