Melasma Treatment

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    Melasma (dark spots on skin)

    Melasma is a common skin issue that manifests as dark, discolored patches on the skin, most commonly seen during pregnancy. It is interchangeably known as “mask of pregnancy” and clinically referred to as “chloasma facei”. It primarily is seen over the bridge of the nose, the forehead, the cheeks, and the upper lips on the face and otherwise sometimes affects the forearm and the neck as well. As per the statistics of the American Academy of Dermatology, only 10 percent of men are affected while women are at a higher risk of developing this pigmentation especially during pregnancy and those who bear darker complexion. These patches appear symmetrically on both sides of the face and their pigmentation varies from a tan color to deep brown. 

    As it mostly affects the face, it is important to treat this condition whereas it is not as critical in itself unless allowed to get worsened. Symptoms of melasma can be controlled by certain measures and approaches which should be done correctly. It is not associated with any severe health-related risks but if increased has the potential to affect mentally and cause a reduction in self-esteem. 

    Causes of melasma:

    • The most common cause of these patches is exposure to sunlight. Any consumption of medicines or applications of topical creams that are photosensitizing can increase the risk of developing these colored patches.
    • Some cosmetics or medicines that are used to treat ovarian and thyroid problems can also cause melasma.
    • Birth control pills and hormone replacement medicines.
    • Genetic predisposition
    • Women with light brown skin who are living in regions that have exposure to excessive sunlight.
    • Any thyroid malfunction that leads to overproduction of melanocyte-stimulating hormone.
    • Allergic reactions to medications and cosmetics

    Symptoms:

    • Dark, irregular but well-demarcated macules or skin patches
    • Patches can vary from size of 0.5 cm to 10 cm
    • These patches can be Centro facial, malar or mandibular
    • Less commonly these patches can appear on the arm or neck
    • Skin gets darkened over time 
    • It does not cause any pain, itching or burning sensation.

    Risk Factors & complications:

    Risk factors:

    • Pregnancy
    • 90% women are at a more risk
    • Family history of melasma
    • Hispanic individuals, Africans and Central Asians
    • Fitzpatrick skin type IV to VI
    • Estrogen dominance and other hormonal imbalances
    • Birth control pills 
    • Sun and ultraviolet light exposure
    • History of certain medications
    • History of thyroid dysfunction
    • Stress, as it can trigger overproduction of MSH

    Complication of Melasma:

    If not treated, the patches can be permanent which may not cosmetically be acceptable by people. There are no major complications associated with this condition. 

    Diagnosis of melasma:

    • It is easily diagnosed through a visual examination. 
    • Wood Lamps’ Examination: this lamp illuminated Ultraviolet light that helps in getting a clear view of the patches’ pattern, sun damage, and layers of the manifestation that cannot be seen otherwise. It also helps to identify if there is any bacterial or fungal infection present.
    • Skin biopsy: a small portion of the skin is taken and assessed for any underlying disease like Addison’s disease, maturational dyschromia, lupus, or any skin cancer. 

    Treatment of melasma:

    In Pregnancy, melasma goes away and clears off by the end of the gestation period and birth of the baby. It requires to be treated cosmetically as there are not even any physical symptoms like pain and itching associated with. 

    Women who take oral contraceptives or hormone replacement therapy often see the patches fade once they stop taking the medications. This is because the imbalance in hormone is restored. 

    A few other ways by which the patches or pigmentation can fade off are:

    • Hydroquinone is a topical cream that reduces and almost removes the pigmentation from the skin. It inhibits the chemical processes that cause or direct to the production of melanin, the pigment that is responsible for making the skin dark. 
    • Tretinoin is a type of vitamin A that stimulates peeling off of dead skin and promotes the formation of new skin. This causes the patches to gradually fade and the skin becomes clear once all the patches are shed. 
    • Azelaic acid cream appears to work by slowing down or stopping the production of pigment, the substance that makes the skin darker.
    • Application of other topical steroids that lighten up the skin color
    • Chemical peels are chemical liquid solutions that are applied on the affected patch of the skin to cause a mild chemical burn which resembles a sunburn. With time, these burned layers peel off leaving fresh and new skin. Examples of such chemicals are glycolic acid, which of all is the mildest of all and has fewer chances of skin scarring. This method is used only when other strategies do not work. Other chemical solutions are mostly Phenols, trichloroacetic acid (TCA), and alpha hydroxy acids (AHAs). Which one to use completely depend on the severity of the patches and the darker skin lesions are. Few to categorize are as follows:

    Mild peels: It is the least severe form of chemical peeling. It involves using solutions containing alpha hydroxyl acids. Usually, the procedure lasts for 10-20 minutes, and pain is minimal. Recovery of your skin can take up to six days.

    Medium peels: Medium peels use trichloroacetic acid. It is severe when compared to mild peels. Recovery time is longer. There can be visible signs like redness of the skin and swelling. However, these signs disappear with time, and the results last longer. 

    Deep peels: Deep peels often make use of phenols. They cause skin burns and should be used with care. Deep peels penetrate deep into your skin and the effects last longer than mild or medium peels. It is essential to know that the pain associated with deep peels is severe. Therefore, make sure it’s your last resort before you go ahead.

    • Intense Pulsed Light therapy utilizes certain wavelengths of light to target and removes pigmented areas of skin.
    • Laser treatments
    • Microdermabrasion is a painless cosmetic procedure where the skin’s outermost layer is exfoliated and leaves the skin soft and glowing 

    There is no need of any oral medications or tablets as it does not really cause intense systemic reactions or problems. 

    Prevention of melasma:

    • Cover your sun-exposed areas such as cheeks, forehead, and lips every time you walk out in the sun.
    • Apply sunscreen with SPF 30 or more every day.
    • Wearing a hat for an outdoor activity is also a good option.
    • Avoid sunbath during pregnancy.
    • If you are on certain skin treatment, follow it well for the best result.
    • Avoid scrubbing as it may irritate the skin. 
    • Wear makeups right for you skin 

    Melasma is a skin condition where there is no infection involved and is mostly treated by topical application, skin therapies and practising good skin hygiene. Also, it has high chances of recurrence so the preventive strategies should not be ignored.