Melasma

Melasma is a skin disorder which is often seen in women. The disorder presents with large brown patches on the face. Even though it most often occurs on the sun exposed areas of the body, the skin discoloration can occur anywhere on the body. The brown patches are attributed to the skin pigment (melanin). It is felt that during these pigment cells for some reason become overactive and start to secrete the pigment which eventually makes the skin brown or dark.

In most cases, the skin discoloration is on the superficial skin (epidermal melasma) but often it can affect the deeper (dermal melasma) skin layers. Superficial melasma is easier to treat than the dermal variety.

On the face, melasma is most common on the cheeks and the nose but it can also occur on the lips and forehead.

The disorder is rarely seen in men. The skin condition is more common in dark skinned individuals, esp. Asians, Orientals and Hispanics. In Caucasians the disorder is rare but can occur. The condition occurs world wide and is most common in parts of the world where the sun exposure is constant and intense.

Melasma is rarely seen before puberty and most commonly occurs in women during their reproductive years. It is rare after menopause.

Causes

Genetics: Why this skin disorders occurs is unknown, but there is a strong family history in most sufferers.

Pregnancy: Melasma commonly occurs during the later stages of pregnancy and may cover the entire face. It is often referred to as the "Mask of Pregnancy". Most women suffer from some degree of facial skin discoloration during pregnancy and this is transient in the majority. Repeat pregnancies may be associated with recurrent episodes of melasma. Only the rare individual has permanent melasma after pregnancy.



Oral contraceptives: Melasma has also been linked to the birth control pill. Women who take the pill commonly develop the skin rash on the face. The rash generally disappears when the pill is stopped. The melasma usually takes months and sometimes even years to dissipate. However, the condition is not seen in females who take hormone replacement therapy after menopause.

Sun: Of all the risk factors, exposure to sun has been strongly associated with melasma; the rash is commonest in areas of the world where women are exposed to intense sun. When the face is covered, melasma almost never occurs. It is felt that the skin pigments are increased during sun exposure.

Skin irritation: The condition has been known to occur after skin irritation. Any type of skin irritation coupled with sun exposure will darken the skin color

In the majority of cases, the condition is easily diagnosed by the presenting features and history. There are no tests to make a diagnosis. In the rare case, when the diagnosis is in doubt, a skin biopsy is done

One thing to remember about Melasma. It is a harmless condition and not associated with any symptoms. And in the majority it resolves on its own.