Melasma appears as a symmetrical blotchy, brownish pigmentation on the face. The pigmentation is due to overproduction of melanin by the pigment cells of the skin. This condition may be upsetting and can lead to considerable emotional distress.
The cause of melasma is complex. There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people, melasma is a chronic disorder. Melasma is more common in women than in men, and in people that tan well or have naturally brown skin. It generally starts between the age of 20 and 40, but can begin in childhood or middle-age. Melasma presents as freckle-like spots commonly located on the cheeks, forehead, nose, chin, and above the upper lip.
There are several known triggers for melasma. More commonly, it arises in apparently healthy, normal, non-pregnant adults and persists for decades. Exposure to the sun deepens the pigmentation because it activates the color producing cells of the skin. Sun exposure is the most important avoidable risk factor. Pregnancy may also induce or make melasma worse. Birth control pills may cause melasma, however hormone replacement therapy used after menopause has not been shown to cause the condition. Scented or deodorant soaps, toiletries and cosmetics may cause a phototoxic reaction triggering melasma that may then persist long-term.
Management of melasma requires a comprehensive approach by your dermatologist. While there is no cure for melasma, many treatments have been developed. Melasma can be very slow to respond to treatment, so don’t get discouraged if you don’t see immediate results. General measures include year round strict sun protection with a very high SPF sunscreen applied to the affected areas daily, using a mild cleanser and light moisturizer, and cosmetic camouflage make-up is available to hide the pigment. If you are on birth control or other hormones, stopping these medications may help fade the pigment.
Bleaching creams, such as hydroquinone, is the mainstay of treatment. It must be apply to the affected areas daily for at least 4 months. Other topical therapies include azelaic acid, kojic acid, alpha hydroxy acid, vitamin C, soybean extract, and topical retinoids may help fade the pigment. We may also recommend certain chemical peels and laser treatments such as intense pulsed light (IPL) if your melasma is persistent.