Melasma

Melasma, a common skin condition characterized by brown or gray-brown patches on the face, often results from a combination of factors. It’s more prevalent in women, especially during pregnancy (when it’s known as chloasma or the “mask of pregnancy”) and is more common in individuals with darker skin types.

  • Causes:
    • Sun Exposure: UV radiation stimulates melanocytes, the melanin-producing cells, leading to hyperpigmentation.
    • Hormonal Changes: Pregnancy, oral contraceptives, and hormone therapy can trigger melasma.
    • Genetic Factors: There is often a family history of melasma and it is more common in darker skin types.
    • Skin Irritation: Certain skin care products can worsen melasma.
  • Diagnosis:
    • History (Hx):
      • Onset and Duration: When the patches first appeared and any changes over time.
      • Sun Exposure: Amount and protection measures.
      • Hormonal Factors: Pregnancy, birth control use, hormone therapies.
      • Family History: Similar skin conditions in family members.
      • Skin Care Routine: Use of cosmetics or products that may irritate the skin.
    • Examination (Ex):
      • Visual Inspection: Distribution, color, and pattern of the patches.
      • Wood’s Lamp Examination: To assess the depth of skin pigmentation.
    • Investigations (Ix):
      • Skin Biopsy: Rarely needed, but can help rule out other causes of hyperpigmentation.
      • Blood Tests: To check for hormonal imbalances if suspected.
  • Management:
    • Topical Agents: Hydroquinone, tretinoin, medium potency corticosteroids, azelaic acid, and kojic acid can be used to lighten the skin.
    • Chemical Peels: Glycolic acid and trichloroacetic acid peels can help in skin lightening for epidermal melasma.
    • Laser Treatments: Procedures like intense pulsed light (IPL) and fractional lasers, though their effectiveness can vary.
    • Sun Protection: Regular use of broad-spectrum sunscreen with SPF 50+, hats, and wearing sun-protective clothing.
    • Cosmetics: Makeup to cover the patches.
    • Oral Medications: Tranexamic acid in some cases (like hydroquinone this inhibits tyrosinase enzyme needed to make melanin)
    • Monitoring and Follow-up: Regular follow-up to monitor the response to treatment and manage side effects.
  • Prevention:
    • Sun Avoidance and Protection: Minimize sun exposure and use sunscreens.
    • Avoid Known Triggers: Such as birth control pills or other hormonal treatments if they are implicated.
    • Gentle Skin Care: Avoid harsh skin care products that can irritate the skin.
  • Special Considerations:
    • Pregnancy: During pregnancy, treatment options are limited due to safety concerns for the fetus.
    • Darker Skins: In individuals with skin of color, treatments must be used cautiously to avoid over-lightening of the skin or worsening of the pigmentation.
    • Expectations: It’s important to manage expectations as melasma can be a chronic and relapsing condition. Treatment might not completely erase pigmentation and maintenance therapy is often necessary.