Melasma: The Basics

Melasma is skin discoloration (tan, brown, blue or black) found most commonly on sun-exposed areas of the face.

What causes melasma?

Melasma is a common skin disorder. Though it can affect anyone, women with darker skin tones (especially Hispanic, Asian, Indian, and Middle Eastern) are at greatest risk. Melasma can be associated with the female hormones estrogen and progesterone. It is especially common in pregnant women, women who are taking oral contraceptives, and women taking hormone replacement therapy during menopause. The use of cosmetics is associated with melasma but the relationship between the two is not understood. Sun exposure is strongly associated with melasma.

What are the symptoms of melasma?

Melasma has no associated symptoms.

What does melasma look like?

Melasma causes irregular tan, brown, or even blue/black patches on parts of the face including cheeks, forehead, nose, chin, jaw line, and upper lip. It is most often symmetrical (matching on both sides of the face).

How is the diagnosis of melasma made?

Your physician can usually diagnose melasma based upon the appearance of your skin. Your physician may want to examine your skin with a Wood’s lamp to help guide treatment.

What treatment options are available?

The best treatment for melasma is prevention. The key to preventing melasma is sun avoidance and daily sunscreen use. However, for most of us, it is too late for prevention, and there are a number of treatment options available.

Bleaching Creams

• What they are?

Over-the-counter creams contain 2 percent hydroquinone, a bleaching agent. Prescription creams may use single agents, such as Retin-A (tretinoin) or combinations of medications such as hydroquinone with tretinoin plus a cortisone cream.

• What are the risks?

Over the counter bleaching creams are usually well tolerated and may gradually lighten melasma over a couple of months. However, they are not very effective. Prescription formulations are often more effective but may have more side effects (such as redness, drying, and peeling) and are expensive. Creams may not work for everyone and the risks and benefits need to be discussed with your physician.

Chemical Peels

• What are they?

Your physician can administer a peel using a variety of different chemicals to remove age spots, melasma, freckles, wrinkles, and fine lines. Chemical peels may smooth and firm the skin and may lighten dark areas gradually. The superficial peels, such as a glycolic acid peel can be done during your lunch hour, and there is no recovery time. Deeper peels are more effective but require longer recovery. See more details under discussion chemical peels.

• What are the risks?

Different kinds of peels carry different risks. Superficial peels are usually quite safe. However, you may need a series of superficial peels (done approximately once a month) before you'll notice improvement. Costs can add up if you choose a series of peels. The risks and benefits vary depending on the kind of peel and need to be discussed in detail with your physician.

Laser Resurfacing

• What is it?

Laser resurfacing is an in-office treatment where age spots, melasma, wrinkles, and fine lines are “burned” off with a laser. Laser resurfacing can remove most age spots, melasma, and wrinkles, often in just one treatment. Some lasers, such as the CO2 laser are considered the gold standard in terms of facial rejuvenation. With good sun protection, the effects can last up to five years. See more details under discussion of lasers.

• What are the risks?

Lasers actually remove the outer portion of the skin- called the epidermis. Because of this, you may experience some pain as well as redness and peeling. You may even form scabs in the days after the procedure. Expect recovery time of at least a week. Laser therapy is also expensive. One treatment can cost anywhere from $1,000 to $5,000, depending on how much of your face is treated. The risks and benefits of laser resurfacing need to be discussed in detail with your physician.

Intense Pulsed Light Therapy (IPL)

• What is it?

IPL is one of the newer forms of facial rejuvenation. Unlike lasers, which use intense, focused light, IPL is intense broadband light. Although IPL delivers energy to both the superficial and deep layers of the skin, the epidermis is spared from damage. Thus, there is virtually no recovery time. In the studies that have been performed so far, IPL can smooth the skin and fade age spots, freckles, melasma, and even broken blood vessels. Improvements usually last for about a year with good sun protection.

• What are the risks?

IPL is safer than laser therapy because IPL does not damage the epidermis. There may be some pain during the procedure but no recovery time. Unlike laser therapy, however, you may need multiple treatments (average is 4-6, at three weeks intervals) to get the full benefit. The cost is variable, but is usually more expensive than peels and less expensive than lasers. The risks and benefits of IPL therapy need to be discussed in detail with your physician.

What are some causes and treatments for melasma?

Melasma is said to be a form of pigmentation on the face usually mistaken for a tan, appearing around the cheeks, forehead, upper lip, nose, chin, and jaw line. It also may appear on the forearms, but this is quite rare. Although it is most common in women of childbearing age, you don?t even have to be women to be afflicted by it. Up to 10% of cases are shown in dark skinned men. Although there is no real cure, there are steps you can take to avoid it, to minimize the visible effects and keep them at a minimum. Successful treatment usually begins with the trio of sunblocks, bleaching creams and time.

Sun exposure is said to be the biggest culprit. In the summer, melasma tends to darken after exposure to the sun, fading in winter when the sun is not as harsh. Melanin absorbs the energy of the sun?s rays in order to protect the skin, tanning occurs as a result, causing dark areas to get even darker.

The melasma pregnancy mask syndrome impacts Latino and Asian women primarily, producing darkened coloring spots on the face. Skin inflammations from allergic reactions, or waxing of facial hair especially above the lip, can also be a trigger, in addition to a predisposition to the affliction. Some medications can also contribute to the cause, such as the antibiotics like tetracycline, and some anti-seizure and anti-malarial drugs.

The good news is that melasma symptoms tend to fade over time, usually a 3 to 4 month period after initial manifestation. Laser skin resurfacing offers a relatively successful and controlled short-term strategy to the facial areas affected by melasma. Chemical peels are also a consideration. An alternate for use may be steroidal creams and even skin bleaching cream formulations that include hydroquinone or retinoic acid- these tend to produce encouraging results.

It is vital that you avoid the sun contraceptive pills that are prone to this type of reaction. Lifestyle choices have a heavy impact on the rise and spread of melasma. Since genetics and family heredity are key initial factors, but avoidance of these two main elements can really impact the continued affliction.

Complex factors may trigger melasma in women, as well as the 15% of men that are afflicted. Topical creams have been known to have great results, as have skin bleachers, chemical peels and laser skin resurfacing all provide positive results. Left alone, and not intensified by sun exposure, melasma tends to stay around for less than a year. Impacted skin cells with the discoloration are "surface" cells, and melasma becomes "permanent" is if the discolored area splits, allowing these hyper-pigmented cells to go deeper into the skin layers. When the discolored cells with melasma are settled within your deeper dermal tissue levels, they resist conventional treatments.

Be aware of the health of your skin is a major responsibility. Try to avoid drying your skin out, as well as over moisturizing it. It is a good rule of thumb to avoid sun exposure, but to use sunscreen daily with at least an SPF 30 rating while taking in the appropriate supplements to counter the sun's rays, ensuring both your inside health and outside appearance are as well as they can be.

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