(281) 557-3223

  • Facebook
  • Twitter
  • Google+
  • Instagram
  • YouTube
  • Pinterest

Melasma: A Common Skin Problem and Treatments

Melasma, also known as chloasma faciei, or the mask of pregnancy when present in pregnant women, is a tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications.

Signs and symptoms

The symptoms of melasma are dark, irregular, well-demarcated hyperpigmented macules/patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Melasma is also common in pre-menopausal women. It is thought to be enhanced by surges in certain hormones.

Melasma Causes

Melasma is thought to be the stimulation of melanocytes (cells in the epidermal layer of skin that produce a pigment called melanin) by the female sex hormones, estrogen and progesterone, to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.

Genetic predisposition is also a major factor in determining whether someone will develop melasma.

The incidence of melasma also increases in patients with thyroid disease. It is thought that the overproduction of melanocyte-stimulating hormone (MSH)–brought on by stres–can cause outbreaks of this condition. Other rare causes of melasma include allergic reaction to medications and cosmetics.

Melasma Suprarenale (Latin – above the kidneys) is a symptom of Addison’s disease, particularly when caused by pressure or minor injury to the skin, as discovered by Dr. FJJ Schmidt of Rotterdam in 1859.

Diagnosis

Melasma is usually diagnosed visually or with assistance of a Wood’s lamp (340 – 400 nm wavelength). Under Wood’s lamp, excess melanin in the epidermis can be distinguished from that of the dermis.

Differential diagnosis

Post inflammatory hyperpigmentation

Actinic lichen planus

Hydroquinone-induced exogenous ochronosis

Treatments

The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.

Treatments are often ineffective as it comes back with continued exposure to the sun. Assessment by a dermatologist will help guide treatment. This may include use of a Wood’s lamp to determine depth of the melasma pigment. Treatments to hasten the fading of the discolored patches include:

  • Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.
  • Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
  • Azelaic acid (20%), thought to decrease the activity of melanocytes.
  • Tranexamic acid by mouth has shown to provide rapid and sustained lightening in melasma by decreasing melanogenesis in epidermal melanocytes.
  • Cysteamine hydrochloride (5%) over-the-counter. Mechanism of action seems to involve inhibition of melanin synthesis pathway.
  • Flutamide (1%).
  • Chemical peels.
  • Microdermabrasion to dermabrasion (light to deep).
  • Galvanic or ultrasound facials with a combination of a topical crA?me/gel. Either in an aesthetician’s office or as a home massager unit.
  • Laser, but not IPL (IPL can make the melasma darker)

Evidence-based reviews found that the most effective therapy for melasma includes a combination of topical agents.

In all of these treatments the effects are gradual, and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.

Patients should avoid other precipitants, including hormonal triggers.

Cosmetic camouflage can also be used to hide melasma.

From Wikipedia, the free encyclopedia

Schedule a Consultation

Athré Facial Aesthetics offers a wide range of facial plastic surgery options and non-surgical cosmetic and skincare treatments. Find the right one for you by contacting our office at (281) 557-3223 or click the button below to request a consultation.

Request a Consultation

MEET DR. RAGHU ATHRÉ

HOUSTON'S TOP FACIAL PLASTIC AND RHINOPLASTY SURGEON

Dr. Athré is one of the few cosmetic and reconstructive surgeons in Houston who is a double board-certified Facial Plastic Surgeon, certified in Otolaryngology and Head/Neck Surgery.

Read more

Contact Us