Melasma is a common skin problem presenting as dark, irregular-shaped patches with well- defined edges on face. Upper cheeks, nose, lips, upper lip, forearms, neck, and forehead are usually affected by discoloration. Melasma develops slowly but can last for many years. Sun exposure triggers melasma, so it often worsens in the summer and improves during winter.It does not cause any physical symptoms beyond the discoloration.

Who Gets Melasma

Melasma mostly affects pregnant women, and those taking birth control pills or hormonal therapy. Only 10-20 % of people who get melasma are men.

• Those living in areas of intense sun exposure
• People with dark skin tones including Asian and Indianshave more active melanocytes than those with light skin and thus are more prone to melasma.
• People who have a blood relative who has melasma

Causes

The exact cause of melasma is not yet known. It occurs when the color- making cells in the skin (melanocytes) produce too much pigment (color).
Factors contributing to melasma include:

• Family history
• Pregnancy or use of birth control pills
• Cosmetics or other skin care products
• Phototoxic medicines (drugs that make the skin more sensitive to light damage, such as anti-seizure medication)
• Sun exposure
• Stress
• Thyroid problems

Melasma during pregnancy (chloasma or “the mask of pregnancy”) may result from an increase in hormone production. The main risk factors of melasma in men are sun exposure and a positive family history.

Ultraviolet (UV) light from the sun exposure stimulates the melanocytes, triggering melasma. Sun exposure is the main reason for recurrence of melasma after fading.

Skin care products that irritate the skinmay trigger an increase in melanocytes and worsen melasma. Melasma does not cause any internal diseases or organ malfunction.

Diagnosis

Dermatologists diagnose (detect) melasma by visual examination.

Treatment

Sometimes melasma fades on its own, such as after a pregnancy or stopping birth control pills. Some patients can have it for years or even a lifetime.

Skin-Lightening Agents

The most common is skin-lightening medicine is hydroquinone. The effect hydroquinone treatment usually become evident after 5 to 7 weeks and treatment often continues for at least 3 months.

Your dermatologist may combine different skin-lightening agents to enhance the lightening effect.

Chemical Peels

Chemical peeling involves applying compounds to the skin to induce exfoliation (removal of dead skin cells).

Microdermabrasion

Microdermabrasion is a skin resurfacing method which uses rough, but very fine crystals to buff away (abrade) the outermost layers of the skin. This procedure uses a vacuum-like device to apply the particles and then remove the unwanted skin with suction.

Maintenance Treatment

Though treatments are effective, they do not always cure melasma. Skin discoloration may not go away completely. Depending on how much pigmentation you have and how sensitive your skin is, you may need more than one treatment to see a good result. The effectiveness over time varies from patient to patient and it may take a few months to see improvement. Even after your melasma clears, you may need maintenance therapy can prevent melasma from returning.

Sun Protection

Daily sunscreen use is an essential part of melasma treatment. When selecting a sunscreen, select one that offers board-spectrum protection protects against UVA and UVB rays. It should have an SPF (sun-protection factor) of 30 or more. Products that contain zinc oxide or titanium oxide physically block the sun’s rays. Even after your melasma clears, continue to wear sunscreen to prevent the melasma from recurring.

It is important not to use products that irritate the skin. Any cosmetics (facial cleanser, cream, makeup, etc.) that irritate the skin may worsen melasma.

Treating melasma requires a multifaceted approach, under the care of a dermatologist, many people have a successful outcome.