Melasma is a common skin condition in which patches of skin on the face darken. Loosely translated, the word means “black spot.” If you have melasma you’re probably experiencing light brown, dark brown and/or blue-gray patches on your skin. They can appear as flat patches or freckle-like spots. Typically, the affected areas are the cheeks, bridge of the nose, forehead or upper lip. The dark patches are often symmetrical. Melasma can occur in anyone, but is much more frequently found among women, especially women who are pregnant when it is called chloasma and is sometimes referred to as the "pregnancy mask." Although not a painful or dangerous problem, melasma can be very distressing emotionally because of its alteration of the appearance. Melasma is not always a permanent condition. It may disappear in a woman several months after she gives birth but may reoccur after unprotected exposure to the sun.
What happens to the skin in Melasma?
The skin is made up of three layers. The outer layer is the epidermis, the middle is the dermis, and the deepest layer is the subcutis. It’s an organ – the largest organ – and it makes up about one-seventh of your body weight. The epidermis contains cells called melanocytes that store and produce a dark color (pigment) known as melanin. In response to light, heat, or ultraviolet radiation or by hormonal stimulation, the melanocytes produce more melanin, and that’s why the skin darkens.
Symptoms and Causes
What causes melasma?
There are two main causes of melasma: radiation, whether ultraviolet, visible light, or infrared (heat) light; and hormones.
Ultraviolet and infrared radiation from the sun are key in making melasma worse. Other possible causes of melasma include:
- Antiseizure medications: Drugs that prevent you from having seizures may be a cause of melasma. An example of an antiseizure medication is Clobazam (Onfi®).
- Contraceptive therapy (birth control): Melasma has been observed in individuals who use oral contraceptive pills that contain estrogen and progesterone.
- Estrogen/Diethylstilbestrol: Diethylstilbestrol is a synthetic (man-made) form of the hormone estrogen. It’s often used in treatments for prostate cancer. Again, there’s a pattern between increased estrogen and melasma.
- Genetics: About 33% to 50% of people with melasma have reported that someone else in the family has it. Many identical twins both have melasma.
- Hypothyroidism: A condition where your thyroid is underactive.
- LED Screens: Melasma may be caused by the LED lights from your television, laptop, cell phone and tablet.
- Pregnancy: It is unclear why “the mask of pregnancy” happens to pregnant women. However, experts theorize that the increased levels of estrogen, progesterone and the melanocyte-stimulating hormones during the third trimester of pregnancy play a role.
- Hormones: Hormones like estrogen and progesterone may play a role in some people. Postmenopausal women are sometimes given progesterone, and have been observed developing melasma. If you aren’t pregnant, you likely have elevated levels of estrogen receptors found in your melasma lesions.
- Makeup (cosmetics): Some cosmetics can cause what’s called a phototoxic reaction.
- Phototoxic drugs (medicines that make you sensitive to sunlight): These include some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycemics, antipsychotics, targeted therapies and some other drugs.
- Skin care products: A product that irritates your skin in general will likely make your melasma worse.
- Soaps: Some scented soaps are thought to cause or worse melasma.
- Tanning beds: The UV light produced by tanning beds damages your skin just as bad as the UV light from the sun, and sometimes worse.
What are the signs of melasma?
Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. Sometimes the patches can become red or inflamed. Melasma appears in six locations or a combination of locations on your skin:
- Brachial: Melasma appears on your shoulders and upper arms.
- Centrofacial: The melasma appears on your forehead, cheeks, nose and upper lip.
- Lateral cheek pattern: The melasma appears on both cheeks.
- Malar: The melasma appears on your cheeks and nose.
- Mandibular: The melasma appears on the jawline.
- Neck: In people age 50 or older, melasma can appear on all sides of the neck.
Diagnosis of Melasma
Melasma is usually diagnosed through a simple physical examination of the skin. A Wood's lamp, which uses ultraviolet light, is used to highlight skin discolorations and direct the course of treatment.
How is melasma treated? What medicines help?
The first thing you need to do to treat your melasma is to make sure that it doesn’t get any worse. Do this by avoiding the sun, tanning beds, LED screens, irritating soaps and birth control that includes hormones. If you are exposed to the sun, be sure to wear sunscreen with iron oxides and a SPF of 30-50 applied every two hours, as well as a wide-brimmed hat. These steps may prevent your melasma from getting worse.
The second path to take is topical medications. The combination of hydroquinone, tretinoin and a moderate topical steroid has had the best effect on melasma.
Treatment for Melasma
Sometimes patients may achieve symptom relief if they stop taking estrogen and progesterone, and balancing the hormones linked to the disorder.
A topical treatment isn’t your only option. There are some procedures that your dermatologist can do to improve your melasma.
- Chemical peel: In this procedure, your dermatologist will put a chemical on your skin that may make it peel. The skin that regenerates should be smoother and more evenly colored.
- Light-based procedures like intense pulsed light, non-ablative fractionated lasers and low fluence lasers can help.