Melasma is a common skin disorder seen in men and especially women. It is quite commonly seen in pregnant women and is often referred to as the “mask of pregnancy”. It presents itself as a dark facial skin rash with irregular borders. The rash is usually recognized by its symmetrical presentation on the cheeks, lips, nose or forehead. Skin discoloration can also occur on the upper arms. The skin discoloration can vary in color ranging from a dark brown to a deep grey.
The condition is universal and seen in all cultures and ethnicities; however it is far more commonly seen in Asians, Hispanics, Arabs and North Africans who all seem to have higher levels of melanin in their skin and a tendency to tan. Individuals with fair skin may experience a lighter shade of melasma which is not always recognized.
Learn more about the top Melasma treatment options:
Causes of Melasma
The cause of melasma remains unknown but is believed to be due to an increase in the production of cells which release the pigment melanin, which is responsible for the dark color of the skin.
What causes the increased production of melanin is not known but some triggers include:
- Heredity factors and hormone fluctuation/production: the rash is most common in pregnant females
- Prolonged sun exposure
- Use of birth control pills
- Certain medications like tetracycline and anti-malarial drugs (derived from quinine)
Melasma is not related to any medical disorder and by itself is a harmless skin condition despite the cosmetic concern associated with its appearance on facial skin. Diagnosing melasma in pregnant women is relatively simple, yet in men and women who are not pregnant, drug related skin reactions and other medical conditions may have to be ruled out. A skin biopsy may be performed for diagnosis in some cases.
Melasma is usually a transient skin disorder that may resolve itself. This may occur after childbirth in pregnant women. In cases where the melasma occurs in men or non-pregnant women, it may exist for a few months to a few years and then suddenly disappear. Thus treatment is not always warranted and it is difficult to know if and when the rash will remain and in whom it will disappear.
Over the years, various treatments developed to treat melasma including:
- Chemical peels. The most commonly used acid compounds to remove melasma include trichloroacetic acid, azelaic acid, glycolic acid, lactic acid and various fruit extracts. Stronger peeling agents tend to have a higher effectiveness rate than lighter strength peeling agents. Stronger peeling agents may also carry the risk of side effects such as burning, skin peeling, scarring and even worsening the skin discoloration.
- Skin lightening agents. There are many skin lightening agents on the market and the most commonly used is hydroquinone. Numerous other agents sold in herbal and nutrition stores may work as skin lightening agents as well, however each patient has a unique skin type and reactions to skin lightening agents vary.
- Sunscreens, especially those which are mineral based, such as zinc and titanium.
- Laser skin rejuvenation
These treatments do not necessarily cure the cause of melasma and the effectiveness of each will vary from patient to patient. Even after treatment, skin discoloration may not always disappear completely and each patient may have to try various different treatment options to see a satisfactory result. Some treatments may have to be continually performed to sustain results, such as applying a skin lightening agent on a regular basis, combined with effective sunscreen usage and sun exposure avoidance.
To help prevent melasma from worsening, patients may wear sunscreen which contains a mineral based shield from the sun with an SPF at least 20. Protective clothing and wearing a hat may help to prevent melasma from worsening. Protective facial make-up may also be worn to help even skin tone and block out the sun.
Consulting with a local cosmetic dermatologist in your area may offer skin care opportunities for melasma that are right for you. Find a local skin care clinic in your area!
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Photos courtesy of P. Bitter Jr., MD
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