What is Melasma?
Melasma is a common skin problem in women occurs in between the age 20-50. If it occurs during pregnancy it is called Chloasma. Skin Becomes patchy brown, blue-gray facial discoloration of the skin, gets tanned if affected by melasma. It usually occurs on the upper lip, upper cheeks, chin and forehead. Melasma rarely occurs in males. It is more common in women. The causes of melasma are considered as external hormones like birth control pills, internal hormone changes during pregnancy and sun exposure. Most of the people suffering from melasma are having a history of intermittent or daily sun exposure; heat is also surmised to be a fundamental factor.
Melasma especially occurs in Latin and Asian origins. The higher incidences of melasma are found in people with darker skin, like Asian, Middle Eastern and Hispanic individuals. Prevention is mainly focused on protecting the face from sun exposure and avoiding sun exposure. Regular application of sunscreens, usage of medications with 4% of hydroquinone and attenuating creams.
Causes of Melasma:
The proper reason for the cause of melasma is still not known. It is believed that the dark patches in melasma are caused by various factors like hormone replacement therapy (HRT), birth control pills, pregnancy, race, hereditary, medications which make the skin prone to pigmentation after UV exposure and antiseizure medications. Over sunlight exposure is also a major factor of occurrence of melasma. It is mostly occurred in the months of summer, in winter the hyperpigmentation tends to be unnoticeable or lighter.
If melasma occurs during pregnancy, it is called as chloasma. In pregnant women, the levels of hormones like estrogen, progesterone and melanocyte-stimulating hormone are high during second and third trimesters which is considered as a cause of melasma. Melanocytes are the skin cells that deposit pigment. In pregnancy period the melasma is caused due to the high progesterone levels.
Using skin products that cause irritation to the skin also leads to melasma. If there are people with melasma in the family then the chances are more for getting melasma.
Types of Melasma:
Melasma is diagnosed as four types of pigmentation patterns: dermal, epidermal, mixed and an unnamed one found in dark-skinned individuals. The dermis type is identified by the presence of melanophages in the dermis. Epidermal melasma is distinguished by the presence of excess melanin at the superficial level of the skin. The mixed type melasma includes both dermal and epidermal type. In the fourth type, melasma over melanocytes is present in dark-skinned people.
The common melasma treatments include 2% of hydroquinone creams. Studies show that creams containing 2% HQ are effective in skin lightening and are less irritating than other high concentrations of HQ. These creams are applied onto the brown patches twice a day. Every morning sunscreen should be applied over the hydroquinone cream. There are treatments for melasma types, but the epidermal melasma responds better to treatment than the others as the pigment is close to the skin surface. Melasma may clear spontaneously without treatment. Other times, it may clear with sunscreen usage and sun avoidance. For some, the melasma discolorations will disappear after pregnancy or discontinue of birth control pills and hormone therapy. Melasma is reduced spontaneously without any specific treatments by the application of sunscreen and sun avoidance. For treating melasma creams with the following ingredients must be used
- Azelaic acid 15%-20% (Azelex, Finacea)
- Retinoic acid 0.025%-0.1% (tretinoin)
- Tazarotene 0.5%-0.1% (Tazorac cream or gel)
- Adapalene 0.1%-0.3% (Differin gel)
- Kojic acid
- Lactic acid lotions 12% (Lac-Hydrin or Am-Lactin)
- Glycolic acid 10%-20% creams (Citrix cream, NeoStrata)
- Glycolic acid peels 10%-70%