Melasma
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
- Melasma is a chronic skin condition causing brown patches to appear, mainly on the face.
- Triggered not only by sunlight but also by visible light from devices and indoor lighting.
- Tinted sunscreens are recommended to block visible light and UV.
- Requires lifelong management with no definitive cure available.
- Treatment with hydroquinone is gold-standard. Other medical and cosmeceutical agents can also be beneficial.
- Physical treatments such as peels and lasers can help manage the condition, but can also worsen the condition when performed inappropriately.
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. Contact Melbourne skin clinic for dermatology services and treatments tailored to your skin care needs.
- Chronic condition causing blotchy, brownish pigmentation.
- Symmetrical pattern, primarily facial.
- Exacerbated by UV and visible light.
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.
- Predominantly affects women.
- Linked to hormonal changes, like pregnancy.
- Not limited by age or ethnicity, although not seen in children.
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.
- Darkened, well-demarcated patches.
- Symmetrical distribution.
- Gradual development.
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.
- Diagnosed based on appearance.
- A Wood’s lamp examination is sometimes performed.
- Biopsy rarely used for diagnostic confirmation.
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.
- Psychological impact due to visibility & chronicity.
- Can cause distress and self-consciousness.
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.
- Epidermal - dark brown, well-defined.
- Dermal - light brown/bluish, less defined.
- Mixed - combination of both types.
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.
- Portrayed as challenging to treat.
- Focus on cosmetic impact.
- Emphasised need for comprehensive light protection.
- Treatment with a dermatologist for challenging cases.
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.
- Triggered by UV and visible light, including device screens.
- Hormonal changes, particularly in women.
- Certain medications and cosmetics as potential triggers.
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 Measures
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 Treatments
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.
Oral Treatments
In severe cases, oral treatments such as tranexamic acid may be considered, although these are typically secondary to topical treatments and lifestyle measures.
Physical Treatments
Professional treatments like chemical peels, microdermabrasion, and laser therapy can be effective but can exacerbate the condition when not performed by experienced professionals.
Things to Avoid
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.
Expectations and Outcomes
Melasma requires lifelong management and is not curable. Treatments may only offer partial improvement, and the condition often requires ongoing attention to prevent exacerbation.
- Comprehensive light protection is essential.
- Topical agents are the primary treatment, but long-term use requires caution.
- Oral and physical treatments are secondary options.
- Lifelong management required as there is no cure.
Our results speak for themselves
Unfiltered and untouched standardised 3D Vectra before & after photographs of consenting patients at Melbourne Skin & Dermatology. Individual results may vary. A thorough consultation is required before treatments.
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