Melasma is an acquired hyperpigmentation of sunexposed skin areas, or in plain English, “dull brown spots.” It presents as symmetric hyperpigmented spots which can be separated or bunched together along the cheeks, nose, the upper lip, the chin and the forehead, and can occasionally occur in other sun-exposed locations. Melasma spots are dark, irregular brown-toblack patches that gradually, over time, may develop into mask-like patterns.
What Causes Melasma?
The exact cause of melasma is uncertain. In many cases, there is a direct relationship with female hormonal activity because melasma occurs with pregnancy and with the use of oral birth control pills. Other factors related to melasma include “sun” sensitizing medications, mild ovarian or thyroid dysfunction, and certain cosmetics.
Yet the most important factor in the development of melasma is exposure to sunlight. Without the strict avoidance of sunlight, potentially successful treatments of melasma are doomed to fail. Tanning bed exposure has increased the incidence of melasma in the United States. Melasma, though distressing, is a benign process.
Melasma is rare before puberty and most commonly occurs in women during their reproductive years. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy (HRT) medications. It is much more common in women than in men; in fact, women are affected in 90 percent of cases. When men are affected, the clinical presentation is identical. Melasma does not cause any other symptoms beyond the cosmetic discoloration. However, the facial discoloration can be devastating.
Persons of any race can be affected by melasma, however, it is much more common in people of darker skin types than in lighter skin types, and it may be more common in light brown skin types from areas of the world with intense sun exposure. Melasma is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian Jewish descent (on the face).
Melasma is usually diagnosed by a physician visually or with assistance of a Wood’s lamp (black lamp). Under the Wood’s lamp, excess melanin pigments in the epidermis can be identified. Some melanin deposits are superficial in the skin while others may be deep in the dermis. The deeper the pigment deposits, the more difficult it is to treat. The discoloration of melasma usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.
Melasma Treatment
Treatments to hasten the fading of the discolored patches include; topical depigmentation creams, acid peels, and laser skin resurfacing. Depigmentation creams such as hyproquinone (HQ) can be used directly on the dark spots. HQ is a chemical that inhibits a specific enzyme involved in the production of melanin pigments. Acids ointments are used to increase skin cell turn-over, pushing the brown discolorations to the surface so rapidly that it results in pigment fading. Other acid treatments are thought to decrease the activity of melanocytes or pigment cells.
When topical treat-ments fail, most patients proceed with facial peels using alpha hydroxy acids or chemical peels with glycolic acid. Yet, some of the most dramatic changes in melasma spots have been attained with laser skin resurfacing treatments. In all of these treatments, the effects are gradual and a strict avoidance of sunlight is required before, during and after completion of therapy. The use of broad-spectrum sunscreens with physical blockers such as titanium dioxide and zinc dioxide is preferred over that with other chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production. Say goodbye to the tan beds! Last, but not least, cosmetic makeup can be used to reduce the appearance of melasma. Melasma, though annoying, has no known relationship to skin malignancy.
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