Melasma

Melasma is a common skin condition that causes dark, discoloured patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Often referred to as the "mask of pregnancy" due to its prevalence in expectant mothers, melasma can affect anyone. This condition can be distressing, especially for individuals who feel self-conscious about their appearance. 

Understanding the causes, risk factors, and treatment options for melasma can help manage its impact and prevent further skin discolouration. In this article, we’ll look into the details of melasma, covering its causes, symptoms, diagnosis, and available treatments.

Melasma is a type of hyperpigmentation that results in the appearance of dark, brownish patches on the skin. These patches are most commonly found on the face, but melasma can also affect other areas of the body that are exposed to the sun. The discolouration occurs when there is an overproduction of melanin, the pigment that gives skin its colour.

While melasma can affect anyone, it is more common in women, especially during their reproductive years. It is often associated with hormonal changes, such as those that occur during pregnancy or with the use of birth control pills. However, exposure to the sun, certain medications, and genetic predisposition can also contribute to the development of melasma.

Melasma is a widespread condition, with a higher prevalence in areas where there is more sun exposure. It is most commonly seen in individuals with darker skin types, such as those with Hispanic, Asian, and African descent. Worldwide, it affects up to 15% of the population, but its prevalence is significantly higher in women, especially during their reproductive years.

In India, melasma is a major concern, affecting a large proportion of the population. A study conducted in India found that nearly 50% of women aged 25 to 40 were affected by melasma, with many seeking dermatological treatment for the condition 

Melasma can be categorised into three main types, depending on the depth of the pigmentation and the location of the patches:

1. Epidermal Melasma: This type of melasma is characterised by dark, well-defined patches located on the surface layer of the skin. Epidermal melasma is usually responsive to treatment, such as topical creams.
2. Dermal Melasma: Dermal melasma occurs deeper within the skin, affecting the dermal layer. This type of melasma is more difficult to treat and may require more intensive treatments such as laser therapy.
3. Mixed Melasma: As the name suggests, mixed melasma involves a combination of both epidermal and dermal pigmentation. This type is often the most challenging to treat, as it may require a combination of topical treatments and procedures.
    

The primary cause of melasma is an overproduction of melanin, but several factors can trigger or worsen the condition:

Hormonal Changes

Hormonal fluctuations are one of the leading causes of melasma. Pregnancy, particularly during the second and third trimesters, can trigger melasma due to the increase in hormones such as oestrogen and progesterone. This is often referred to as the "mask of pregnancy." The use of oral contraceptives or hormone replacement therapy can also contribute to the development of melasma.

Sun Exposure

Ultraviolet (UV) light from the sun is a significant factor in triggering melasma. UV rays stimulate the production of melanin, which leads to the dark patches seen in individuals with melasma. Even brief exposure to the sun can worsen the condition.

Genetics

Melasma tends to run in families, suggesting a genetic predisposition to the condition. People with a family history of melasma are more likely to develop it themselves.

Medications

Certain medications, such as birth control pills, hormone replacement therapy, and anticonvulsants, can contribute to melasma by affecting hormone levels. Some topical medications can also cause photosensitivity, making the skin more susceptible to UV damage.

Skin Irritation

Some cosmetic products or treatments that irritate the skin can contribute to melasma. This irritation can trigger increased melanin production in the affected areas.

The primary symptom of melasma is the appearance of dark, brown or greyish-brown patches of skin, usually on the face. These patches are most commonly found on:

• Cheeks
• Forehead
• Nose
• Chin
• Upper lip

These patches are typically symmetrical, meaning they appear on both sides of the face. They may vary in size and can blend into the surrounding skin, making them harder to spot initially.

A dermatologist can typically diagnose melasma based on its appearance. A thorough skin examination will be performed to assess the pattern, location, and depth of the pigmentation. In some cases, a Wood's lamp examination may be used to determine whether the pigmentation is epidermal or dermal.

In rare cases, a biopsy may be performed to rule out other skin conditions that may mimic melasma. This procedure involves removing a small sample of the affected skin for analysis under a microscope.

Treatment options for melasma are available, though they vary depending on the severity and type of melasma (Brands available: Melacare, Skinlite). Some common treatments include:

Topical Treatments

• Hydroquinone: This is one of the most commonly prescribed topical treatments for melasma. It works by inhibiting melanin production, lightening dark patches over time.
• Tretinoin: A topical retinoid that can speed up skin turnover and promote the shedding of pigmented skin cells.
• Corticosteroids: These are often used in combination with other treatments to reduce inflammation and lighten the skin.
• Azelaic Acid: This ingredient works to lighten skin discolouration and reduce melanin production.

Chemical Peels

Chemical peels use acids to exfoliate the skin and promote the removal of pigmented skin cells. Glycolic acid and salicylic acid are commonly used in chemical peels for melasma.

Laser Treatments

Laser treatments, such as fractional lasers and intense pulsed light (IPL), target the melanin in the skin to break it up and fade dark spots. Laser therapy may be more effective for dermal melasma, although it may require several sessions.

Microdermabrasion

Microdermabrasion is a non-invasive procedure that removes the outer layer of skin to improve the appearance of melasma. It works best for mild cases of the condition.

Some people may seek alternative therapies to help manage melasma. While these treatments can be beneficial, they are not always scientifically proven to be effective. Some options include:

• Vitamin C: Known for its skin-brightening properties, Vitamin C can help lighten dark patches.
• Green Tea Extract: Studies suggest that green tea extract may reduce melanin production and help lighten skin.
• Licorice Extract: Licorice contains glabridin, a compound that has been shown to inhibit melanin production and brighten skin.

Several factors can increase the likelihood of developing melasma:

• Gender: Women are more likely to develop melasma, especially during their reproductive years.
• Age: Melasma is more common in adults, particularly between the ages of 20 and 50.
• Ethnicity: People with darker skin tones are at higher risk.
• Sun Exposure: Prolonged exposure to the sun, without adequate protection, can trigger or worsen melasma.
   

While melasma itself is not harmful, it can cause emotional distress, especially for those who are self-conscious about their appearance. In rare cases, severe sun exposure or improper treatment can lead to scarring or hyperpigmentation that may be difficult to reverse.

Living with melasma requires ongoing care and patience. Here are some tips:

• Consistency is key: Follow your dermatologist's treatment plan and be consistent with your skincare routine.
• Wear makeup for confidence: If melasma affects your self-esteem, use makeup that provides full coverage to conceal the dark patches.
• Stay out of the sun: Even with treatment, exposure to UV rays can worsen melasma. Always wear sunscreen.

Melasma only affects women: While it is more common in women, men can also develop melasma.

Melasma goes away on its own: Melasma often requires treatment and doesn’t resolve on its own.

Laser treatment is the only solution: Several treatments are available, and laser therapy is not always the most appropriate option for everyone.

If you notice discoloured patches on your skin that don't fade with sunscreen or home remedies, it's time to consult a dermatologist. Also, if your melasma worsens or if you experience new symptoms, seek professional advice.

1. What treatment options are best for my type of melasma?
2. Are there any side effects associated with the treatments you’re recommending?
3. How long will it take to see improvements in my skin?
4. Should I avoid certain skincare products or ingredients?
5. How can I best prevent melasma from coming back?
    

If someone close to you is struggling with melasma, offer emotional support and encourage them to seek professional treatment. Understand that melasma can affect self-esteem, and be compassionate in your approach.

Melasma is a common yet treatable skin condition that affects many people worldwide. While the condition itself is not harmful, it can cause emotional distress, especially for those who are affected by visible discolouration on their skin. By understanding the causes, symptoms, and available treatments, you can manage melasma effectively. With the right care, support, and preventive measures, melasma can be kept under control, allowing you to feel more confident in your skin.