by Beatriz G. Carpo, MD
Melasma is a very common skin condition wherein tan, brown to grayish patches appear on the cheeks, cheekbones, forehead, forehead, bridge of the nose, and upper lip, or chin. In a few patients it can even involve the sides of the neck, shoulders and upper arms. It is more common in women, especially in the ages of 20-50's. It is also seen more frequently in darker skin types and certain races such as Asian, Hispanic, Latin, African-American, Mediterranean, and Indian descent.
Although the exact cause is unclear, the following are the major triggering and aggravating factors in melasma.
- Ultraviolet Light Exposure (UV). This and hormonal changes play the biggest roles in Melasma. Ultraviolet rays stimulate the skin's color-producing cells (melanocytes) to produce the dark patches. Patients with melasma should always use sunscreen and practice sun avoidance.
- Hormonal Changes. Melasma is common In pregnancy when it is called "Mask of Pregnancy" or "Chloasma". The use of birth control pills and hormone replacement pills also serve as triggers.
- Genetics. There is also a genetic predisposition and having a close relative with melasma increases your risk of getting melasma.
- Cosmetics and skin products that cause skin irritation may aggravate melasma. Certain ingredients in skin products may make you more sensitive to the ultraviolet rays of the sun and these may worsen melasma.
Sun protection and the daily use of sunscreen is of utmost importance. Even visible light indoors may aggravate melasma. When outdoors, it would be good to also wear a wide-brimmed hat and proper clothing for extra sun protection.
Medications that may help improve or lighten melasma include:
- LIghtening creams. These include Hydroquinone and Non-hydroquinone products like arbutin, azelaic acid, kojic acid, etc.
- Tretinoin- this may be prescribed in combination with lightening creams.
- Mild steroidal creams- this may also be used in certain cases. It is used to decrease the irritation from other applied medications like tretinoin for instance.
- Dermatological procedures- this may include chemical peels, microdermabrasion, and laser. Results from laser procedures may be varied. These must be tailored and individualized based on the severity, and skin types and characteristics.
WHAT TO EXPECT:
Melasma can be quite stubborn and may stay for months to years. But with a guided treatment advice by a dermatologist, you may be able to lighten and improve it.
You may need some form of maintainance therapy to keep it under control.
SOME HELPFUL TIPS:
- Wear a good sunscreen daily. Both outdoor and indoor light may worsen melasma. There is significant UV outdoors even on cloudy days.
- Wear a protective hat when outdoors as sunscreen use may not be enough.
- Use gentle skin products. Products that irritate skin can worsen melasma.
- Avoid heat. Heat can irritate skin and can trigger the cells that produce the color of your skin (melanocytes) to become more active.
If you have melasma, consult a Dermatologist to discuss medications or clinic procedures that may help improve it.
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