Barefaced
by auria
Notes on change, skin, and the journey to your truest self.
by auria
Notes on change, skin, and the journey to your truest self.
Melasma is a hyperpigmentation disorder resulting in the development of symmetrical, brown or grayish patches primarily on the face. These patches often appear on the cheeks, forehead, nose, and upper lip. It is more common in women, particularly those of childbearing age, and is frequently observed in individuals with darker skin. While the condition itself is not harmful, the cosmetic impact can be significant. It is important to consult with a dermatologist for a proper diagnosis and treatment plan.
Melasma exhibits a significant prevalence, ranging from 4% to 25% across different populations. This condition is especially prevalent in individuals with skin of color, including those of Hispanic, Asian, and African descent. Women are disproportionately affected, accounting for a substantial majority of diagnosed cases. The most common age range for melasma onset is between 30 and 45 years old. Understanding these demographic trends aids in recognizing potential risk factors and addressing specific patient needs.
Diagnosing melasma involves a careful examination of the skin by a dermatologist. The characteristic appearance of symmetrical, blotchy hyperpigmentation on sun-exposed areas, such as the cheeks, forehead, or upper lip, is a key indicator. A Wood's lamp examination, which uses ultraviolet light, can sometimes help to distinguish melasma from other pigmentary disorders and determine the depth of the pigmentation. Although rare, a skin biopsy may be performed to rule out other conditions if the diagnosis is uncertain.
While the exact cause of melasma remains elusive, several factors are known to contribute to its development. Sun exposure, hormonal changes, genetic predisposition, and certain medical conditions are all implicated in the pathogenesis of this complex skin disorder. Identifying and managing these contributing factors is crucial in developing an effective treatment strategy.
Exposure to ultraviolet (UV) radiation from the sun is a primary trigger for melasma. UV rays stimulate melanocytes, the pigment-producing cells in the skin, leading to increased melanin production and the formation of dark patches. Consistent and diligent sun protection is therefore essential in preventing and managing melasma. This includes:
Hormonal fluctuations play a significant role in the development of melasma, particularly in women. Pregnancy, oral contraceptive use, and hormone replacement therapy are commonly associated with the onset or exacerbation of the condition. Melasma associated with pregnancy is often referred to as "the mask of pregnancy". Hormonal changes can stimulate melanocytes and increase their sensitivity to UV radiation.
A significant genetic component exists in melasma. Individuals with a family history of the condition are more likely to develop it themselves. Studies suggest that approximately 48% of melasma patients have a positive family history. This genetic predisposition highlights the importance of awareness and proactive sun protection for individuals with affected relatives.
![An image differentiating the layers of melasma with clear text labels indicating the depth of pigmentation (Epidermal, Dermal and Mixed). Lighting is diffused, and tones are varying to illustrate the subtle differences between the type of melasma. Background is plain to emphasize the skin.]](/public/images/content_1744675257394.webp)|alt=Visual showing layer of melasma formation]
Melasma can be classified based on the depth of the pigmentation within the skin. Recognizing these types is crucial for tailoring treatment strategies and predicting treatment outcomes. The three primary types of melasma include:
Managing melasma typically involves a combination of strategies aimed at reducing melanin production, protecting against UV radiation, and promoting skin cell turnover. These strategies include topical treatments, chemical peels, and, in certain cases, laser therapy. A personalized approach is essential, considering the individual’s skin type, melasma type, and treatment goals.
Topical treatments are the mainstay of melasma management. Several agents are commonly used to reduce pigmentation and improve skin tone:
A triple combination cream containing hydroquinone, tretinoin, and a corticosteroid is often prescribed. However, prolonged use should only be under medical advice.
Chemical peels involve the application of a chemical solution to the skin, causing controlled exfoliation and promoting the growth of new, less pigmented skin cells. Commonly used peels for melasma include:
It is very important to work with a qualified professional. As darker skin types are more prone to post-inflammatory hyperpigmentation after chemical peels, careful selection of the peeling agent and close monitoring is essential.
Tranexamic acid is an antifibrinolytic agent that is showing promise in melasma treatment. It is used in a lower dose of 250mg per day, with significant outcomes. However, medical supervision is necessary.
Although these treatments are effective, they have side effects like post-inflammatory hyperpigmentation. Therefore, they are considered the last resort. Fractional lasers, like fractional CO2 laser, have shown promise in treating dermal and mixed melasma, which is resistant to topical and chemical peels.
While laser treatments may seem appealing, they pose a significant risk to people with darker skin. If it is not applied carefully, it can worsen the condition. This treatment strategy is useful for those who have not responded to other treatment.
In addition to the risk of hyperpigmentation, laser treatments also carry risks of hypopigmentation (lightening of the skin) or skin inflammation. Patients with darker skin types are therefore advised to explore other safer treatments.
For patients in whom laser treatments are considered too risky, topical treatments are recommended. If this option is not sufficient, chemical peels and oral medications are recommended.
Treating melasma requires a multifaceted approach. It is important to follow treatment plans diligently in order to achieve optimal results. There is no perfect cure for melasma, the main aspect of treatment is management through a sustained period. By implementing preventative measures and following sound medical advice, we can live with this condition.
While there is no permanent cure for melasma, it can be effectively managed with appropriate treatment and preventive measures.
Although it cannot be prevented completely, it is best to have consistent sun protection such as broad-spectrum sunscreen or seeking shade during peak sun hours.
While some natural remedies like lemon juice and aloe vera are often touted for lightening skin, they are not effective for melasma and may cause irritation or damage to the skin. Medical advice should always be prioritised.
Results can vary, but it typically takes several weeks to months to notice a visible improvement in melasma with consistent treatment.
Some topical treatments for melasma are not safe to use during pregnancy. You should consult with your dermatologist on a treatment plan that is safe for you and your baby.
