What is melasma?
Melasma is a pigmentation disorder of the skin that causes brown patches mostly commonly seen on the cheeks and forehead. It is essentially caused by the pigment producing cells (melanocytes) going into overdrive and producing excessive amounts of melanin (the pigment molecule). Melanin is deposited in the skin and tends to just hang around, causing an uneven complexion.
Melasma may cause sufferers feeling self-conscious and can have other psychosocial impacts.
What causes melasma?
There is no one certain cause of melasma. It is known however that 3 main contributing factors are at play;
- Genetics
- Hormones
- Light/UV exposure.
Those with darker skin and from Middle Eastern and Asian backgrounds seem to be more prone to this condition. Approximately 60% of sufferers state that at least one relative also has similar patches on the face. This alone signifies a genetic component.
About 90% of patients with melasma are female. Hence, sex hormones (for example oestrogens) are likely to play a role. If you have heard the term “mask of pregnancy”, then you already know about melasma. Melasma can occur in pregnant women commonly, particularly those in the latter half of gestation. Melasma is also seen in some women who are on hormonal contraception.
One of the most important contributors to melasma is sun and light exposure. Ultraviolet (UV) radiation has long been established to contribute to melasma. UV rays stimulate melanocyte growth and increase production of melanin, the pigment molecule. More attention has also been given to visible light causing worsening of melasma. Hence it’s not just the sun that can worsen melasma, but also light emitted from your TV, light bulbs and possibly even the screen on your mobile devices!
How is melasma treated?
Melasma can be treated using different medicaments which decrease the activity of melanocytes. Sun and light protection are also essential. A combination of different active treatments is often used for a quicker and more predictable result.
Hydroquinone is the gold standard ingredient compounded in most anti-pigmentation creams. It is often combined with other ingredients such as tretinoin and corticosteroids to enhance the effect and reduce side-effects. Other ingredients that have anti-pigmentation properties include azelaic acid, ascorbic acid, kojic acid, licorice extract and glutathione.
More recently, dermatologists have also started using oral tranexamic acid. This is a medication that is prescribed to help improve melasma patches. Glutathione and Polypodium leucotomos are also options, however these agents are less commonly used due to more limited experience and scientific research.
Sunscreen and sun-smart behaviour are essential components of treatment of melasma. Tinted sunscreens are always advisable for patients with melasma as they contain iron oxide pigments that block visible light which, as we have learnt, also contributes to melasma..
Procedures such as chemical peels and laser treatments are also utilised in some situations to reduce or remove the melanin on the surface of the skin. When not performed correctly however, post-inflammatory hyperpigmentation may occur and worsen melasma. Having such procedures performed at reputable clinics is a must.
Melasma is a chronic condition, so maintenance treatment is essential. Episodic flares, especially in summer or with lapses of treatment, are seen often. It can take months to see an initial improvement and sometimes the condition can be very challenging to treat.
Having a good grasp of melasma and understanding the basic causes and principles of treatment is as important as finding the right treatment that works for a specific patient.
References:
https://www.aad.org/public/diseases/a-z/melasma-treatment
https://dermnetnz.org/topics/melasma/
Ogbechie-Godec, O. A., & Elbuluk, N. (2017). Melasma: an Up-to-Date Comprehensive Review. Dermatology and therapy, 7(3), 305–318. https://doi.org/10.1007/s13555-017-0194-1
Sarkar, R., Arora, P., Garg, V. K., Sonthalia, S., & Gokhale, N. (2014). Melasma update. Indian dermatology online journal, 5(4), 426–435. https://doi.org/10.4103/2229-5178.142484
The information presented on this website and in this article is for general information and example purposes only, does not contain health advice specific for users and must not be relied on for that purpose. Please see your GP, dermatologist or other health care professional for specific advice.
