Islamabad Clinic Address:
House 25A, Street 52, Sector F6/4,
Super Market, Islamabad, Pakistan
Tel : 92 51 8733552
92 51 8733553

 

Melasma

MELASMA

What is melasma? What are signs of melasma?

Melasma is a very common patchy brown, tan, or blue-gray facial skin discoloration, almost entirely seen in women in the reproductive years. It typically appears on the upper cheeks, upper lip, forehead, and chin of women 20-50 years of age. Although possible, it is uncommon in males. It is thought to be primarily related to external sun exposure, external hormones like birth control pills, and internal hormonal changes as seen in pregnancy. Most people with melasma have a history of daily or intermittent sun exposure. Melasma is most common among pregnant women, especially those of Latin and Asian descents. People with olive or darker skin, like Hispanic, Asian, and Middle Eastern individuals, have higher incidences of melasma.

 

Prevention is primarily aimed at facial sun protection and sun avoidance. Treatment requires regular sunscreen application and fading creams.

What causes melasma?

The exact cause of melasma remains unknown. Experts believe that the dark patches in melasma could be triggered by several factors, including pregnancy, birth control pills, hormone replacement therapy (HRT and progesterone), family history of melasma, race, antiseizure medications, and other medications that make the skin more prone to pigmentation after exposure to ultraviolet (UV) light. Uncontrolled sunlight exposure is considered the leading cause of melasma, especially in individuals with a genetic predisposition to this condition. Clinical studies have shown that individuals typically develop melasma in the summer months, when the sun is most intense. In the winter, the hyperpigmentation in melasma tends to be less visible or lighter.

 

When melasma occurs during pregnancy, it is also called chloasma, or “the mask of pregnancy.” Pregnant women experience increased estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels during the second and third trimesters of pregnancy. However, it is thought that pregnancy-related melasma is caused by the presence of increased levels of progesterone and not due to estrogen and MSH. Studies have shown that postmenopausal women who receive progesterone hormone replacement therapy are more likely to develop melasma. Postmenopausal women receiving estrogen alone seem less likely to develop melasma.

 

In addition, products or treatments that irritate the skin may cause an increase in melanin production and accelerate melasma symptoms.

 

Anemia, vit D deficiency, thyroid disorders are also the emerging causes of melasma.

 

Whitening facials and skin bleaching done at salons damage skin and eventually uneven skin tones, freckles and melasma start appearing on the skin.

 

Substandard whitening formula creams are also a major cause for hyperpigmentation, increased facial hair growth and acne.

How is melasma diagnosed?
Melasma is usually readily diagnosed by the typical appearance of brown skin patches on the face. Dermatologists are physicians who specialize in skin disorders and often diagnose melasma by visually examining the skin. A Wood’s light (340-400 nm) can assist in diagnosing melasma. In most cases, mixed melasma is diagnosed, which means the discoloration is due to pigment in the dermis and epidermis. Rarely, a skin biopsy may be necessary to help exclude other causes of this local skin hyperpigmentation.
What SPF is recommended for melasma?
A daily sun protection factor (SPF) of at least 30 that contains physical blockers, such as zinc oxide and titanium dioxide, is recommended to block UV rays. Chemical blockers may not fully block both types of UV-A and UV-B as effectively as zinc or titanium. The regular use of sun protection enhances the effectiveness of melasma treatments.
Can melasma be prevented?
It can be kept under control by photofacials.
What is the prognosis for melasma?
Although melasma tends to be a chronic disorder with periodic ups and downs, the prognosis for most cases is good. Just as melasma develops slowly, clearance also tends to be slow. The gradual disappearance of dark spots is based on establishing the right treatment combination for each individual skin type. Melasma that does not successfully respond to treatment are because of a lack of avoidance of sun exposure and non compliance to a daily skin compatible regimen.
What is the treatment for melasma?

There are treatments for all types of melasma, but the epidermal type responds better to treatment than the others because the pigment is closer to the skin surface.

 

Melasma may clear spontaneously without treatment. Other times, it may clear with sunscreen usage and sun avoidance. For some people, the discoloration with melasma may disappear following pregnancy or if birth control pills and hormone therapy are discontinued.

 

In order to treat melasma, combination or specially formulated creams with hypopigmenting agents mentioned below may be prescribed.

  • Azelaic acid 15%-20%
  • Retinoic acid 0.025%-0.1%
  • Tazarotene 0.5%-0.1%
  • Adapalene 0.1%-0.3%
  • Kojic acid
  • Lactic acid lotions 12%
  • Glycolic acid 10%-20% creams
  • Possible side effects of melasma treatments include temporary skin irritation. People who use Hydroquinone treatment in very high concentrations for prolonged periods (usually several months to years) are at risk of developing a side effect called ochronosis. Hydroquinone-induced ochronosis is a permanent skin discoloration that is thought to result from use of hydroquinone concentrations above 4%.
Do lasers work for melasma?

Multiple laser treatments may be necessary to see results, as treatments are most effective when they are repeated.

 

To ensure that treatment doesn’t fail, people must minimize sun exposure. People who treat their melasma report a better quality of life because they feel better about themselves. As with any treatment, people should consult their physician. Pregnant women or mothers breastfeeding may need to wait to treat melasma with creams. Many melasma creams need to be discontinued in pregnancy and breastfeeding because of possible risks to the developing fetus and newborn. These people may consider cosmetics to temporarily conceal the skin discoloration or can have light and laser therapies which can be safely given to pregnant and breast feeding mothers.

Treatment Modalities

There is a mix and match of various treatment modalities to fight this menace on monthly basis.

 

Photofacials