Melasma

What is Melasma?

Melasma, also called as chloasma faciei, is a common skin pigmentation disorder characterized by symmetric brown to gray-brown spots and patches, on the face especially on the cheeks, forehead, bridge of the nose, above the upper lip and chin. It may sometimes appear on other parts of the body that are exposed to a lot of sun, such as the forearms and neck. Melasma is observed in both the genders and in any race, but it is more common in women and people with darker skin types residing in sunny climates. It generally becomes more noticeable in the summer and improves during the winter months.

What are the Causes of Melasma?

The exact cause of melasma is not known but it is believed to be due to the activation of melanocytes by the hormones estrogen and progesterone to produce more melanin when the skin is exposed to the sun. Due to this, women with a brown skin type and residing in regions with intense sun exposure are generally more susceptible to develop melasma.

In pregnant women, melasma is called as chloasma, or the mask of pregnancy. During the second and third trimesters of pregnancy, women experience increased levels of estrogen, progesterone, and melanocyte-stimulating hormone (MSH) hormones leading to increased production of melanin by the melanocytes.

What are the Symptoms and Signs of Melasma?

Melasma is characterized by spots or patches of discoloration which are darker than the person’s normal skin color. These generally appear on the face and are symmetrical, that is, with matching marks on both sides of the face.

Brown colored patches generally appear on the:

• cheeks
• bridge of the nose
• forehead
• chin

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Sometimes, they appear on other parts of the body such as the neck and forearms which generally gets exposed to sun. Melasma doesn't cause any physical harm, but one may become self-conscious about their appearance.

What are the Risk Factors for Melasma?

Melasma is a skin hyperpigmentation disorder and is associated with risk factors such as:

• Uncontrolled sunlight exposure
• Pregnancy: During the second and third trimesters of pregnancy, high levels of estrogen, progesterone, and melanocyte-stimulating hormone (MSH) hormones lead to an increased production of melanin by melanocytes.
• Birth control pills: Intake of birth control pills leads to high levels of estrogen and progesterone in women thereby increasing the risk of developing melasma.
• Hormone replacement therapy: Postmenopausal women who receive progesterone hormone replacement therapy are more susceptible to develop melasma.
• Genetic predisposition: People with a family history of melasma are more prone to this skin disorder.
• Skin color: People with darker skin colors are more susceptible to melasma.
• Occupation: People who work around heat for long times such as cooks are also prone to this disorder as heat can irritate the skin and induce overprod­uction of melanin.
• Medications: Anti-seizure medications, medicines that make the skin more prone to pigmentation following exposure to ultraviolet (UV) light, creams or treatments that irritate the skin may cause an increase in melanin production leading to melasma. Cosmetics that contain perfumes may also increase the risk of melasma.
• Thyroid disease: The occurrence of melasma increases in patients having thyroid disorders.

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• Stress: Recent studies have suggested the role of stress in causing overproduction of melanocyte-stimulating hormone (MSH) leading to melasma. Anxiety traits and psychotropics are closely associated with the development of melasma, making researchers consider melasma as the mask of stress.
• Pollution: Recent studies suggest pollution as a possible emerging risk factor for the development of melasma. Airborne particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) present in the polluted air enter the skin via nanoparticles and generate quinones that lead to the generation of reactive oxygen species (ROS). These ROS then trigger high metalloproteinase levels that lead to skin pigmentation. Interestingly, the incidence of melasma is higher in persons of skin type III-VI residing in India, China, South East Asia and the United States which are also the most polluted geographical regions in the world.

How do you Diagnose Melasma?

If any of the above symptoms of melasma are observed, consult your doctor who might refer you to a dermatologist. In some cases, melasma may not be obvious to the naked eye, and in those cases, dermatologists can detect melasma and its extent using Black light or Wood's light (340-400 nm). Very rarely, dermatologists perform a skin biopsy to differentiate it from other causes of skin hyperpigmentation.

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How do you Treat Melasma?

Melasma generally disappears on its own. In some cases, it may clear with regular sunscreen usage and by avoiding sun. If melasma started during pregnancy, then it will fade following the birth of the baby. If it was caused due to the intake of birth control pills or hormone replacement therapy (HRT), then it disappears once the woman stops taking birth control pills and HRT.

However, in some cases, people have melasma for years-or even throughout their lifetime. If melasma does not disappear on its own or if a woman doesn’t want to stop taking birth control pills, then other treatment options can be tried. Some of the treatments for melasma are:

Hydroquinone: This is one of the most common medication for treating melasma. Hydroquinone comes in the form of cream, lotion, gel, or liquid and when applied to the skin, it works by lightening the skin.

Tretinoin and corticosteroids: Sometimes, dermatologists prescribe tretinoin or a corticosteroid to enhance skin lightening process. These are given either following hydroquinone treatment or as a triple cream (hydroquinone, tretinoin, and a corticosteroid- all in one cream).

Topical medicines: Sometimes, dermatologists prescribe azelaic acid or kojic acid to lighten the melasma.

Proanthocyanidins: These are a class of flavonols and along with vitamin regimens, they have been shown to reduce skin pigmentation significantly.

Home remedies: Orange paste, aloe vera juice, almond and honey face pack, triphala choornam, turmeric powder and milk are some of the home remedies that have been shown to reduce the dark spots.

Cosmetic Procedures: If the melasma does not reduce with medications, then dermatologists perform procedures on the skin such as a chemical peel, microdermabrasion, dermabrasion, laser treatment, or a light-based procedure.

How do you Prevent Melasma?

Although not much can be done to prevent melasma as it is a hormone driven disorder, by including some practices in our everyday routine, the chances of getting melasma and its extent can be reduced.

• Drink lots of water.
• Always eat food items rich in vitamins, iron, fiber and protein.
• It is advisable to have a good fitness regime
• Always use a good sunscreen block with an SPF of 30 before going out in the sun which can protect the skin from the harmful UV-A and B radiations. Use a wide-brimmed hat while going out into the sun when possible.

• Do not use soaps and gels with strong perfumes.
• It is better to use mild and gentle facial cleansers and creams. Do not use strong chemicals based formulations which can aggravate the problem.
• Avoid putting on heavy makeup.
• Always use bathing shower gels that contain natural extracts and less of chemicals.
• Never use skin bleaching agents if you are already having dark spots because it will make your skin look worse.

Health tips

• Drink plenty of water.
• Always eat healthy food rich in vitamins, iron, fiber and protein.
• Do physical exercises daily as sweating will help skin to open the skin pores to release.
• Always use a good sunscreen before going out in the sun.
• Always use good quality facial and body creams that are produced by a reputed brand.
• Include fresh fruit juice in your daily diet.
• Use home remedies to reduce the dark patches.
• Avoid stress as stress is associated with melasma and it aggravates the situation.
• Practice yoga and meditation as that helps the body to fight against stress, infections and diseases.