Learn more about melasma.
Melasma is a common skin condition that presents with symmetrical blotchy, brownish facial pigmentation of the face. It typically affects the forehead, temples, check, cutaneous upper lip and the nose. Onset is usually between ages 20 and 40, and it is more common in women than in men. It tends to occur in people who tan easily have naturally brown skin such as those with Fitzpatrick skin types IV, V and VI. Other risk factors for melasma include pregnancy (melasma gravidarum) and using oral contraceptive medications. About ten percent of cases occur in non-pregnant women and in dark-skinned men.
What causes melasma?
The risk of developing melasma increases with increasing sun exposure. We know this because melasma is less prevalent in winter months and non-tropical areas. It is therefore believed that the underlying changes that occur with persistent sun exposure also underly the onset of melasma. The condition is believed to be caused by the overproduction of melanin by hyperfunctional melanocytes. Melanin is a skin pigment that gives us our skin and hair colour. Increased amounts of melanin are produced in response to sun exposure as it provides a natural defence against ultraviolet rays. This is the mechanism of developing a tan. Sometimes the melanin can be distributed unevenly throughout the skin, leading to blotchy pigmentation such as melasma.
Aside from sun exposure, other risk factors for melasma include autoimmune thyroid disorders and medications that make your skin more sensitive to the sun. Family history appears to be a strong risk factor for melasma. Melasma can affect the epidermal layer, the dermal layer, or both. When it affects the dermal layer, it can be difficult to treat. In women, who are about 5-6 times more likely to develop melasma than men, pigmentation may fade slowly or incompletely after childbirth or when contraceptive medications are discontinued. In men, melasma can be extremely stubborn and resistant to treatment. Low testosterone levels in men may be a contributing factor.
What should you do?
The mainstay of melasma treatment is strict sun protection all year round. We recommend using a sunscreen with a sun protection factor (SPF) that is 30 or higher. Other methods of sun protection include wearing protective clothing and hats and avoiding direct sun exposure, especially during the critical hours of10 AM and 2 PM when the UV index is at its highest.
There are a number of medications that can increase your risk of developing melasma, which is why it is important to provide a full list of your medications to your doctor. Oral contraceptive pills containing oestrogen are known to contribute to melasma. This is because melanocytes are responsive to circulating levels of oestrogen, leading to higher amounts of melanin secretion and increasing the risk of blotchy pigmentation such as melasma. Alternative contraception medications that don’t contain oestrogen might therefore be helpful. Additionally, a medication used to treat seizures may also increase your risk of developing melasma.
There is a range of topical treatments available for melasma. With the right treatments, up to 80% of people will see an improvement or complete clearance of their melasma. Most treatments are used in combination, rather than individually. As a first-line treatment solution at Prescription Skin, we typically prescribe triple topical therapy comprising hydroquinone, tretinoin and a topical corticosteroid. Used short term, topical corticosteroids are a safe and highly effective treatment. They act to block the synthesis and secretion of melanin. This treatment regimen may need to be altered if one or more of the medications are contraindicated, such as during pregnancy. A newly studied oral treatment for moderate-to-severe melasma is tranexamic acid, which also requires a prescription.
NOTE: Chemical peels and lasers should be used with caution, as they can make the melasma worse or cause hyperpigmentation.
