Melasma
What is melasma?
Melasma is a common skin condition predominantly affecting women, characterized by blotchy patches of hyperpigmented skin that appear as tan or dark discolorations across the face—most frequently on the cheeks, nose, forehead, chin, and upper lip. Crucially, melasma is often a hormonally driven condition. This is why it is frequently nicknamed "the mask of pregnancy," as the significant increase in hormones during gestation is a powerful trigger. Similarly, other hormonal factors, such as the use of birth control pills, can provoke its onset.
While sun exposure is a necessary factor to activate the pigment cells and may cause the discoloration to appear on other sun-exposed areas like the forearms and neck, the underlying susceptibility is internal. Melasma develops over time, is more common in skin of color, and tends to run in families. Although the only physical symptom is discoloration, its persistent nature can negatively affect a person's self-image and confidence. Effective management therefore requires not only sun protection but also a treatment strategy that addresses its inherent hormonal sensitivity.
FAQs
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The cause of melasma is unclear, but sun exposure and fluctuations in hormone levels activate the skin cells, called melanocytes, to produce excess melanin, the substance that gives skin its color. Skin of color is more prone to melasma because it has more active melanocytes than lighter skin. Melasma often runs in families.
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Ultraviolet (UV) light from the sun is a major trigger and can aggravate underlying causes like hormonal changes. Even a short exposure to the sun’s light and heat can worsen existing melasma and cause it to return after treatment.
Hormone fluctuations common during pregnancy, oral contraceptives or hormone replacement therapy are known to cause melasma.
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Because of its characteristic appearance, melasma is often diagnosed visually and with the use of a Wood’s Lamp which can distinguish excess melanin in the top skin layer from discoloration in the dermis or lower skin layer. However, because melasma can be caused by an underlying medical condition, board certified dermatologist Dr. Rachel White will review your medical history and determine the triggers that underlie your condition and tailor your treatment specifically.
Treatments for Melasma
First and foremost, treatment is geared at preventing aggravation of the condition by the sun which requires the diligent use of sunscreens that block the sun’s rays as well as light and heat.
There are two kinds of sunscreens: one uses chemicals and the other uses physical blocking agents. The best choice of sunscreen is a physical blocking agent such as zinc and titanium dioxide. When spending time outdoors, wear a hat and long sleeves.
Topical medications to lighten the patches include retinols which when applied speed up cell turnover and facilitate faster clearing of the dark patches. The treatment may include skin lightening cream that contains hydroquinone, a bleaching agent, that is supervised by Dr. White to avoid developing areas of hypopigmentation. Kojic acid, azelaic acid, and cysteamine are also topical skin lighteners that may be recommended.
Additional treatments include chemical peels and laser treatment. Combination treatments are the most effective. Dr. White will personalize a treatment plan to successfully address your specific needs, help the skin heal, and prevent future damage.
Melasma is a frustrating, chronic condition. At RW Dermatology, Dr. White will work with you to obtain a good outcome, including restoring your appearance and confidence. Contact her today to schedule a consultation and learn about all your options.
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