MELASMA

Melasma is a common skin problem. The condition causes dark, discolored patches on your skin.It’s also called chloasma, or the “mask of pregnancy,” when it occurs in pregnant women. The condition is much more common in women than men, though men can get it too. It usually starts between 20 and 40 years of age.

WHAT HAPPENS IN THE SKIN?

Your epidermis ( outer layer of skin ) contains cells called melanocytes that store and produce a dark colour (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 your skin darkens.

COMMON SITES

Melasma causes patches of discoloration. The patches are darker than your usual skin color. Melasma appears most commonly on your cheeks, nose, chin, above the upper lip and the forehead. It sometimes affects your arms, neck and back. In fact, melasma can affect any part of your skin that is exposed to sunlight.

TYPES

Melasma is classified into three types based on the depth of the pigment. The three types are as follows:

1. Epidermal: Epidermal melasma has a dark brown color, a well-defined border, appears obvious under black light, and sometimes responds well to treatment.
2. Dermal: Dermal melasma has a light brown or bluish color, a blurry border, appears no differently under black light, and doesn’t respond well to treatment.
3. Mixed melasma: Mixed melasma, which is the most common of the three, has both bluish and brown patches, shows a mixed pattern under black light and shows some response to treatment.

CAUSES & RISK FACTORS

• There are two main causes of melasma: radiation, whether ultraviolet, visible light, or infrared (heat) light; and hormones.
• The sun’s ultraviolet and infrared light play a role in worsening melasma.
• Melasma can also be caused by the following factors:
• Antiseizure medications: Drugs that prevent you from having seizures may be a cause of melasma. (e.g.:  Clobazam )
• Contraceptive therapy (birth control): Melasma has been observed in individuals who use oral contraceptive pills that contain estrogen and progesterone.
• Estrogen/Diethylstilbesterol: Diethylstilbesterol is a synthetic (man-made) form of the hormone estrogen. It’s often used in treatments for prostate cancer.
• 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: Pregnant women have increased levels of the hormones estrogen and progesterone and the melanocyte-stimulating hormones. These hormones are thought to contribute to your melasma. The darker color usually fades after pregnancy.
• 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.
• Makeup, Skin care products, Soap: A product that irritates your skin in general will likely make your melasma worse. A product that irritates your skin in general will likely make your melasma worse. 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, hypoglycaemics, antipsychotics, targeted therapies, and some other drugs.

DIAGNOSIS

A healthcare provider will examine your skin to diagnose melasma.A visual exam of the affected area is often enough to diagnose melasma. To rule out specific causes, your healthcare professional might also perform some tests.One testing technique is a Wood’s lamp examination. This is a special kind of light that’s held up to your skin. It allows your healthcare professional to check for bacterial and fungal infections and determine how many layers of skin the melasma affects.You might have your thyroid checked because there does seem to be an association between thyroid disease and melasma.Melasma can sometimes be mistaken for another skin condition. To tell the difference between skin conditions, your healthcare provider may perform a biopsy, which is where a small piece of your skin is removed and examined. A biopsy is a quick, safe procedure routinely performed during a normal visit to your healthcare provider’s office.If you notice these symptoms of melasma, see your healthcare professional. They might refer you to a dermatologist, a doctor who specializes in treating skin disorders.

TREATMENT

Currently, there is no cure for melasma; however, there are several medications and procedures available to manage this condition. It is important to know that these treatment options may result in an incomplete response, meaning that some of the discolorations become lighter or disappear while some remain unchanged. In addition, frequent relapses are common.The mainstay of treatment for melasma remains topical depigmenting agents:

• Skin-bleaching creams
• Sometimes chemical peels or laser treatments
• Sun protection
• Treatments applied to the skin are effective only if hyperpigmentation affects the upper layers of the skin.
• Skin-bleaching creams containing hydroquinone, tretinoin, or a corticosteroid can be used in combination to help lighten the dark patches. However, hydroquinone should be used only under the guidance of a doctor, because long-term use can sometimes cause a permanent form of hyperpigmentation.
• A cream containing azelaic acid can be used in place of or combined with hydroquinone, tretinoin, or both.
• Doctors may try chemical peels with glycolic acid or trichloroacetic acid, Laser treatments,  on people who do not respond to skin-bleaching creams.
• During pregnancy, azelaic acid cream and chemical peels with glycolic acid are safe to use. Hydroquinone and tretinoin are not safe to use.
• During and after treatment, people must be strict about sun protection because treatments make the skin prone to sunburn.

PREVENTION

The best way to lower your risk for melasma due to sun exposure is to protect your skin from the sun and ultraviolet (UV) light.Things you can do to lower your exposure to sunlight include:

• Wear clothing such as hats, long-sleeved shirts, long skirts, or pants.
• Try to avoid being in the sun during midday when ultraviolet light is most intense.
• Use high-quality sunscreens, preferably with a sun protection factor (SPF) rating of at least 30. Pick a broad-spectrum sunscreen that blocks both UVA and UVB light.
• Avoid the risk factors mentioned above when possible.

OUTLOOK

• Melasma is common, normal, and harmless, but it can be bothersome.
• There are preventative measures you can take.
• The key point in the management of melasma is to use sun protection all the time and to avoid other triggers such as hormonal medications when possible.
• Since none of the available treatments are a cure, prevention is the best option.
• Always listen to the advice of your healthcare provider and follow your treatment plan carefully.