Melasma

Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on the skin.

Sites of Melasma

Melasma appears in six locations or a combination of locations on the skin.

1. Brachial: The melasma appears on your shoulders & upper arm.
2. Centrofacial: The melasma appears on your forehead, cheeks, nose & upper lip.
3. Lateral Cheek Pattern: The melasma appears on both cheeks.
4. Malar: The melasma appears on your cheeks & nose.
5. Mandibular: The melasma appears on the jawline.
6. Neck: In people age 50 or older, melasma can appear on all sides of the neck.

Types of melasma

1. Epidermal: Epidermal melasma has a dark brown color, and well-defined borders, appears obvious under black light & sometimes responds well to treatment.
2. Dermal: Dermal melasma has a light brown or blush color, a blurry border, appears on differently under black light, and does not respond well to treatment.
3. Mixed melasma: Mixed melasma, which is the most common of the three, has both bluish & brown patches, shows a mixed pattern under black light, and shows some response to treatment.

Cause of melasma

1. UV-rays: Ultraviolet & infrared radiation from the sun are key in making melasma worse. Visible light (VL); in particular high-energy VL (400-450nm) (HEVL), and long-wave UVA (370-400 nm) (UVA1) play a key role in melasma etiology.
2. Genetics: About 33% to 50% of people with melasma have reported that someone else in the family has it. The majority of identical twins both have melasma.
3. Hypothyroidism: One of the hormonal imbalances that can trigger melasma is an underactive thyroid gland, also known as hypothyroidism.
4. LED Screens: Melasma may be caused by the LED lights from television, laptop, cell phone & tablet.
5. Pregnancy: Experts theories that the increased level of estrogen, progesterone and melanocyte-stimulating hormones during the third trimester of pregnancy play a role.
6. Hormones: Hormones like estrogen & progesterone may a role in some people. Postmenopausal women are sometimes given progesterone and have been observed developing melasma. If you are not pregnant, you likely have elevated levels of estrogen receptors found in your melasma lesion.
7. Makeup (Cosmetics): Some cosmetics can cause what’s called a phototoxic reaction.

8. Drugs:

A. Antiseizure medications: Drags that prevent you from having seizures may be a cause of melasma. An example of an antiseizure medication is clobazam.
B. Contraceptive therapy (Birth control): Melasma has been observed in individuals who used oral contraceptive pills that contain estrogen & progesterone.
C. Phototoxic drugs (medicines that make you sensitive to sunlight): These include some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDS), Antifungals, cardiovascular & diuretic agents.

Treatment of melasma

Dermatologists prescribe medication along with procedures that can decrease the excess pigment in the skin.
Most patients receive a prescription for medication that they apply to their skin at home.

1. Medication:

Hydroquinone: This is a common treatment for melasma. It is applied to the skin and works to even out the skin tone. Hydroquinone is no longer available in products that you can buy without a prescription.
Tretinoin & a mild corticosteroid: This combination contains a retinoid and an anti-inflammatory, which can even out skin tone.
Triple combination cream: This cream contains three medication-tretinoin (A Retinoid), a corticosteroid to reduce inflammation, and hydroquinone to even out the tone.
Other medication: Dermatologist may prescribe a medication that’s gentler on your skin like azelaic acid, kojic acid, or vitamin C.

2. Procedures:

To improve the results, dermatologists may add one or more of the following treatment plans :

Chemical peel: During this procedure, dermatologist applies a chemical solution to the melasma. This can help remove excess pigment.
Microneedling: This minimally invasive procedure creates microscopic tears in the skin. As the skin heals, it tends to have a more even shin tone.
Laser & light Treatments: A few studies have found that adding a taser or light treatment can improve results for their skin & protecting their skin from the sun.
Platelet-rich plasma: This procedure involves taking a small amount of your blood, placing the blood into a machine that separates the blood into layers, and then injecting the layer of blood known as plasma into the skin with melasma, this can help even your skin tone.