Melasma (also known as chloasma faciei or the mask of pregnancy when present in pregnant women) is a tan or dark skin discoloration. Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. 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 to 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 thought to be the stimulation of melanocytes (cells in the dermal layer which transfer a pigment called melanin to the keratinocytes of skin) when the skin is exposed to ultraviolet light from the sun. Small amounts of sun exposure can make melasma return to the skin after it has faded, which is why people with melasma often get it again and again, particularly in the summer.
Pregnant women often get melasma, or chloasma, known as the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma. The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.
Genetic predisposition is also a major factor in determining whether someone will develop melasma. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
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 stress 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
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.
Post inflammatory hyperpigmentation
Actinic lichen planus
Hydroquinone-induced exogenous ochronosis (see Ochronosis#Treatments of Exogenous Ochronosis)
Doctor performing treatment for melasma with KTP laser
Assessment by a dermatologist will help guide treatment. 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 is not used during pregnancy due to risk of harm to the fetus.
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
Microdermabrasion to dermabrasion (light to deep)
Galvanic or ultrasound facials with a combination of a topical crème/gel. Either in an aesthetician's office or as a home massager unit.
Laser but not IPL (IPL can make the melasma darker)
Vitamins A, C, and E shows promise as safe and effective for epidermal melasma.
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.
Melasma causes patches of discoloration. The patches are darker than your usual skin color. It typically occurs on the face and is symmetrical, with matching marks on both sides of the face. Other areas of your body that are often exposed to sun can also develop melasma.
Brownish colored patches usually appear on the cheeks, forehead, bridge of the nose, chin. It can also occur on the neck and forearms. The skin discoloration doesn’t do any physical harm, but you may feel self-conscious about the way it looks.
If you notice these symptoms of melasma, see your healthcare professional. They might refer you to a dermatologist, a doctor who specializes in treating skin disorders.
Causes and risk factors of melasma
It isn’t totally clear what causes melasma. Darker-skinned individuals are more at risk than those with fair skin. Estrogen and progesterone sensitivity are also associated with the condition. This means birth control pills, pregnancy, and hormone therapy can all trigger melasma. Stress and thyroid disease are also thought to be causes of melasma.
Additionally, sun exposure can cause melasma because ultraviolet rays affect the cells that control pigment (melanocytes).
How is melasma diagnosed?
A visual exam of the affected area is often enough to diagnose melasma. To rule out specific causes, your healthcare professional might also perform some tests.
One testing technique is a Wood’s lamp examination. This is a special kind of light that’s held up to your skin. It allows your healthcare professional to check for bacterial and fungal infections and determine how many layers of skin the melasma affects. To check for any serious skin conditions, they might also perform a biopsy. This involves removing a small piece of the affected skin for testing.
Is melasma treatable?
For some women, melasma disappears on its own. This typically occurs when it’s caused by pregnancy or birth control pills.
There are creams your healthcare professional can prescribe that can lighten the skin. They might also prescribe topical steroids to help lighten the affected areas. If these don’t work, chemical peels, dermabrasion, and microdermabrasion are possible options. These treatments strip away the top layers of skin and may help lighten dark patches.
These procedures don’t guarantee that melasma won’t come back, and some cases of melasma can’t be completely lightened. You might have to return for follow-up visits and stick to certain skin treatment practices to reduce the risk of the melasma returning. These include minimizing your sun exposure and wearing sunscreen daily.
Ayurvedic treatment for melasma
Ayurveda has mentioned the melasma as Vyang in Kshudraroga by all Acharyas. The etiological factors, pathogenesis of Vyang are explained in Ayurveda. In Vyang vata and pitta dosha is mainly involved. They along with each other due to causative factors suddenly produce Vyang on face region.
Aloe vera application which significantly reduces the blemishes and dark spots on the skin
Orange peel or oatmeal application mixed with milk is a good skin exfoliation and can reduce and lighten skin marks in a few days.
Turmeric paste application. Turmeric plays a very important role in Ayurveda. It is a good antioxidant and has skin lightening properties. It can be applied through many routes like nasal, oral or external application.
Chandana is used to apply externally and cools down the burning sensations
Pitta pacifiers like godanti bhasma, kamaduga rasa, pravala bhasma are all used to treat high order melasma conditions.
External applications of oils like kumkumadi, eladi, kanaka are useful in the treatment of melasma.