What is melasma?
Melasma is a common skin problem causing brown- grey blotchy patches on the face. Most people get it on their cheeks, nose, forehead, and chin and above the upper lip.
Who gets melasma?:
Melasma is far more common in women than in men (9:1) ratio. People with darker skin type- Asians, Indians, Hispanics, Africans and Afro- Americans, Middle Eastern and Mediterranean descent are more likely to get melasma.
What causes or triggers melasma?:
Exact causes are not clear, though it likely occurs when the colour making cells of the skin (melanocytes) produce excessive pigments. Hence people with darker colour skin are more likely to develop melasma as they have more active melanocytes.
Common triggers include;
Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. In fact, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma often is worse in summer. It also is the main reason why many people with melasma get it again and again.
Hormonal changes: Pregnant women often get melasma. When melasma appears in pregnant women, it is called chloasma, or the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma.
Cosmetics: Skin care products that irritate the skin may worsen melasma.
How does it appear?:
It appears as brown or gray-brown patches on the face. These patches most commonly appear on the:
Cheeks.
Forehead.
Bridge of the nose.
Above the upper lip.
Chin.
Some people get patches on their forearms or neck. This is less common.
Melasma does not cause any symptoms (what people feel). But many people dislike the way melasma makes their skin look.
How do dermatologists diagnose melasma?:
Dermatologists can diagnose most patients by looking at their skin. To see how deeply the melasma penetrates the skin, your dermatologist may look at your skin under a device called a Wood’s light.
Sometimes melasma can look like another skin condition. To rule out another skin condition, your dermatologist may need to remove a small bit of skin. This procedure is called a skin biopsy. A dermatologist can safely and quickly perform a skin biopsy during an office visit.
Treatment?
Melasma can fade on its own. This often happens when a trigger is causing the melasma, such as a pregnancy or birth control pills. When the woman delivers the baby or stops taking the birth control pills, melasma can fade.
Some people, however, have melasma for years — or even a lifetime. If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available. These include:
Hydroquinone:
This medicine is a common first treatment for melasma. It is applied to the skin and works by lightening the skin. You will find hydroquinone in medicine that comes as a cream, lotion, gel, or liquid. You can get some of these without a prescription. These products contain less hydroquinone than a product that your dermatologist can prescribe.
Tretinoin and corticosteroids:
To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains 3 medicines (hydroquinone, tretinoin, and a corticosteroid) in 1 cream. This is often called a triple cream.
Other topical (applied to the skin) medicines:
Your dermatologist may prescribe azelaic acid or kojic acid to help lighten melasma.
Procedures: If a topical medicine does not get rid of your melasma, a procedure may succeed. Procedures for melasma include a chemical peel (such as glycolic acid), microdermabrasion, and dermabrasion. A dermatologist should perfrom these procedures. New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type.
If you notice any of the following after treating melasma, be sure to call your dermatologist:
Skin irritation.
Darkening of the skin.
Other problems.
Outcome
Under a dermatologist’s care, many people with melasma have a good outcome. Melasma can be stubborn, though. It may take a few months of treatment to see improvement. It is important to follow your dermatologist’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects.
After your melasma clears, you may need to keep treating your skin. Your dermatologist may call this maintenance therapy. Maintenance therapy can prevent melasma from returning.
General Measures:
Wear sunscreen daily: One of the most common treatments for melasma is sun protection. Since sunlight triggers melasma, it is important to wear sunscreen every day, even on cloudy days and after swimming or sweating. Choose a sunscreen that offers broad-spectrum protection, a Sun Protection Factor (SPF) of 30 or more, and zinc oxide and/or titanium dioxide to physically limit the effects of the sun’s rays on your skin. Apply sunscreen 15 minutes before going outside and reapply at least every two hours.
Wear a wide-brimmed hat and sunglasses when you’re outside: Whenever possible, seek shade and wear protective clothing in addition to applying sunscreen.
Choose gentle skin care products: Choose skin care products that don’t sting or burn, as products that irritate the skin may worsen melasma.
Avoid waxing face: Waxing may cause skin inflammation which can worsen melasma, so it’s important to avoid waxing areas of the body affected by the condition. Ask a dermatologist about other types of hair removal that may be right for you.