Melasma is a chronic skin condition presenting as brown to grey-brown patches, primarily affecting the face. It’s more prevalent in women and is often linked to hormonal changes. Melasma is not only triggered by UV radiation from the sun but also by visible light, including that emitted from device screens and ceiling lights, making comprehensive light protection crucial. Sun protection, including the use of tinted sunscreens that can block visible light, is a key preventive measure.

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Key Points

What is Melasma?

Melasma is a chronic condition resulting in symmetrical, blotchy, brownish facial pigmentation. It primarily affects women and can be exacerbated by both UV and visible light, making it a condition that requires careful and consistent management.

Who gets Melasma?

Melasma predominantly affects women, especially during periods of hormonal fluctuation, such as pregnancy (chloasma) or when using oral contraceptives. However, it can affect anyone and is not limited to a specific age group.

Clinical features

Melasma manifests as darkened patches of skin, often symmetrical. These patches are usually well demarcated and can appear in various shades. The condition often develops gradually over time.

Diagnosis and differential diagnosis

Diagnosis of Melasma is primarily clinical, based on the appearance of the patches. Differential diagnosis includes conditions like post-inflammatory hyperpigmentation, Hori’s naevus and sunspots such as solar lentigines. A Wood’s lamp is sometimes used during assessment.  In some atypical cases, a biopsy may be performed to confirm the diagnosis, however this is rarely performed.

Impact and complications

Melasma can significantly affect psychological well-being due to its visible nature. It may cause distress and self-consciousness in individuals, impacting their quality of life.

Subtypes and variants

Melasma subtypes include epidermal (dark brown, well-defined border), dermal (light brown or bluish, less defined border), and mixed. Each subtype responds differently to treatment.

Melasma and social media and popular press

In social media and the press, Melasma is often highlighted as a challenging condition to treat, with a focus on its cosmetic impact and the importance of comprehensive light protection. A personalsied comprehensive approach with a dermatologist increases the likelihood of successful management.

Causes and triggers of Melasma

Melasma is triggered by both UV radiation and visible light, including light from devices and indoor lighting. Hormonal changes, particularly in women, are a significant factor, along with certain medications and cosmetics.

Treatment Options for Melasma

Treatment of Melasma focuses on managing triggers and prevention. Comprehensive light protection is crucial, including the use of tinted sunscreens. Various topical treatments are available, but careful selection and use are necessary to avoid complications such as exogenous ochronosis, particularly with long-term continuous use of high-strength hydroquinone.

Lifestyle adaptations, such as avoiding direct sun exposure and using broad-spectrum, tinted sunscreens to block both UV and visible light, are essential. Protective clothing such as wearing hats and seeking shade also play a significant role in managing Melasma.

Topical agents like hydroquinone, tretinoin, and corticosteroids are commonly used. However, it’s important to be aware that prolonged and continuous use of high-strength hydroquinone can lead to complications like exogenous ochronosis, resulting in a darkening of the skin. Other topical treatments used include tranexamic acid, licorice root extract, azelaic acid and cysteamine.

In severe cases, oral treatments such as tranexamic acid may be considered, although these are typically secondary to topical treatments and lifestyle measures.

Professional treatments like chemical peels, microdermabrasion, and laser therapy can be effective but can exacerbate the condition when not performed by experienced professionals.

It’s important to avoid harsh skin treatments and direct sun exposure, which can aggravate Melasma. Patients should also be cautious about using certain cosmetics or medications that may trigger the condition. Laser & physical treatments should be avoided unless performed under a specialist medical dermatology clinic.

Melasma requires lifelong management and is not curable. Treatments may only offer partial improvement, and the condition often requires ongoing attention to prevent exacerbation.

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