Melasma or chloasma is a discoloration of the facial skin, often affecting women during pregnancy. Melasma is a dark skin discoloration found on sun-exposed areas of the face. Chloasma is a synonymous term sometimes used to describe the occurrence of melasma during pregnancy. Chloasma usually affects women but occasionally is seen in young men who use after-shave lotions, scented soaps, and other toiletries. Chloasma is especially common in women aged 20-40. It affects the forehead, cheeks and upper lips. It occurs frequently during pregnancy and is more common in dark skins than in fair skins. Chloasma usually affects women but occasionally is seen in young men who use after-shave lotions, scented soaps, and other toiletries. Melasma is much more common in women than in men. Women are affected in 90% of cases. When men are affected, the clinical and histologic picture is identical. Melasma is rare before puberty and most commonly occurs in women during their reproductive years. Melasma is often associated with the female hormones estrogen and progesterone.
Melasma is a darkening of the facial skin, commonly affecting the apples of the cheeks, the mid forehead, jawline and areas around the mouth. Melasma doesn’t cause any other symptoms besides skin discoloration but may be of great cosmetic concern. Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates. Melasma appears on the skin’s surface as dark or irregular patches. Melasma is not associated with any internal diseases or organ malfunction. Genetic predisposition is also a major factor in determining whether someone will develop melasma. Bleaching creams contain hydroquinone, which inhibits formation of new pigment. Bleaching creams take 3 to 6 months to obtain a worthwhile lightening of pigmentation. Allergic reactions to medication or cosmetics, and in some cases stress, can produce the condition.
Repeated superficial chemical peels (glycolic acid or Jessner solution) may be helpful. Creams containing tretinoin, kojic acid, and azelaic acid have been shown to improve the appearance of melasma. Laser resurfacing is sometimes worthwhile but should be performed cautiously as it can aggravate pigmentation. Avoiding the sun and using sunscreen are key to preventing melasma. Chemical peels, microdermabrasion, and even some lasers can be effective treatments. Exposure to the ultraviolet light (sunlight and tanning booths) must be minimized. Sunscreens or sunblocks must be used. Azelaic acid (20%), thought to decrease the activity of melanocytes. Facial peel with alpha hydroxyacids or chemical peels with glycolic acid. Cosmetic cover-ups can also be used to reduce the appearance of melasma. Successful treatment usually begins with the trio of sunblocks, bleaching creams and time. Minimizing sun exposure can prevent darkening of existing dark patches, as well as the appearance of new areas.
Melasma Treatment Tips:
1. Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength.
2. Tretinoin, an acid that increases skin cell (keratinocyte) turnover.
3. Azelaic acid (20%), thought to decrease the activity of melanocytes.
4. Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.
5. Laser resurfacing is sometimes worthwhile but should be performed cautiously as it can aggravate pigmentation.
6. Cosmetic cover-ups can also be used to reduce the appearance of melasma.
7. Azelaic acid inhibits formation of pigment and is also effective against acne.
8. Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles.
