Melasma causes brownish patches to appear on the skin, most commonly on the face. One form of melasma that appears during pregnancy is called chloasma, also called the “mask of pregnancy” but melasma can occur for other reasons and even on other parts of the body that receive excessive sun exposure. Though melasma occurs more often in women aged 20 to 50 years old, approximately 10 percent of people with melasma are men. People who are from cultures with darker skin and those who have a blood relative with melasma are more likely to develop it.
The actual cause of melasma is not known. Experts believe that there may be certain factors that trigger the excess production of melanin from melanocytes in the skin. Hormones, specifically estrogen and progesterone, seem to be the most common triggers, which is why it can occur during pregnancy, but also the use of birth control pills or hormone replacement can cause it.
Exposure to UV light is also thought to be a prominent cause so avoidance of excess sun exposure is crucial. Certain medications, such as those used to prevent seizures, may make one more prone to developing melasma, and some people with thyroid disease are susceptible.
A dermatologist can determine if you have melasma by examining your skin. By using a special lamp called a Wood’s lamp, he can determine which of the four types of melasma you have: epidermal, dermal, mixed, or an unnamed type found in those with dark complexions. He will then decide what type of creams would be best to try to lighten the melasma.
Hydroquinone: Hydroquinone works by decreasing the production and increasing the breakdown of melanosomes (melanin pigment granules) in the skin's pigment cells (melanocytes) according to demantz.com. Over the counter it is sold as a 2 percent solution and by prescription can be made stronger up to 4 percent. Often hydroquinone is prescribed mixed with trentinoin and corticosteroids, in a triple combination cream to enhance their action.
Tretinoin and corticosteroids: Trentinoin contains retinolic acid and acts to increase the turnover of cells to rejuvenate the skin but it also tends to work slowly. Corticosteriods act to reduce inflammation.
Azelaic acid acts similarly to hydroquinone to lighten skin by blocking melanocytes but is stronger. Kojic acid is another type of depigmenting solution.
If topical creams fail to reduce the melasma, other procedures may be options such as chemical peels (using glycolic acid), microdermabrasion or dermabrasion. Use of lasers is expensive and may cause other skin problems such as scarring so typically are avoided.
Avoidance of sun exposure is the main factor in preventing melasma from worsening. Wearing sunscreen with an SPF over 30 and wearing wide brimmed hats must be done routinely. Sunscreens with zinc oxide or titanium oxide act to actually block the sun’s rays so may be more effective. According to the American Academy of Dermatology, you should apply sunscreen every day and be sure to apply it 20 minutes before you go outside.
Melasma Symptoms, Signs, Causes, Diagnosis, Treatment, Prevention and Prognosis by MedicineNet.com. Retrieved August 7, 2011, from http://www.medicinenet.com/melasma/article.htm
Melasma. American Academy of Dermatology. Retrieved August 7, 2011, from
Melasma | DERMAdoctor. Retrieved August 7, 2011, from http://www.dermadoctor.com/article_Melasma_55.html
How Do You Treat Melasma | Melasma Treatment. Melasma Treatment | Causes & Removal. Retrieved August 7, 2011, from
Edited by Jody Smith
Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues. Other articles by Michele are at www.helium.com/users/487540/show_articles