Melasma

Alternative Names : Chloasma; Mask of pregnancy; Pregnancy mask

Definition:-
Melasma is a dark skin discoloration found on sun-exposed areas of the face.
Melasma (also known as chloasma or the mask of pregnancy when present in pregnant women) is a tan or dark facial skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications. It is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian Jewish descent (on the face).

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Symptoms:-

Melasma doesn’t cause any other symptoms besides skin discoloration but may be of great cosmetic concern.A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face).
The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.

Cause:-

Melasma is a very common skin disorder. Though it can affect anyone, young women with brownish skin tones are at greatest risk.

Melasma is often associated with the female hormones estrogen and progesterone. It is especially common in pregnant women, women who are taking oral contraceptives (“the pill”), and women taking hormone replacement therapy during menopause.

Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates.
Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.

Genetic predisposition is also a major factor in determining whether someone will develop melasma.

The incidence of melasma also increases in patients with thyroid disease. It is thought that the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can cause outbreaks of this condition. Other rare causes of melasma include allergic reaction to medications and cosmetics.

Melasma Suprarenale (Latin – of the adrenals) is a symptom of Addison’s disease, particularly when caused by pressure or minor injury to the skin, as discovered by Dr. FJJ Schmidt of Rotterdam in 1859.

Diagnosis:-
Your health care provider can usually diagnose melasma based upon the appearance of your skin. A closer examination using a Wood’s lamp may help guide your treatment.Melasma is usually diagnosed visually or with assistance of a Wood’s lamp (340 – 400 nm wavelength). Under Wood’s lamp, excess melanin in the epidermis can be distinguished from that of the dermis.

Treatment:-
The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.

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Treatments to hasten the fading of the discolored patches include:

*Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.

*Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
Azelaic acid (20%), thought to decrease the activity of melanocytes.

*Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.

*Laser treatment. A Wood’s lamp test should be used to determine whether the melasma is epidermal or dermal. If the melasma is dermal, laser (or “IPL”) will acually DARKEN and worsen the appearance of the spots. Dermal melasma is generally unresponsive to most treaments, and has only been found to lighten with products containing mandelic acid.

In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.

Cosmetic cover-ups can also be used to reduce the appearance of melasma.

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Prognosis:
Melasma often fades over several months after stopping oral contraceptives or hormone replacement therapy or after delivering a child. It may return with additional pregnancies or use of these medications.

Prevention :
Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Melasma
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000836.htm

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2 thoughts on “Melasma”

  1. Hello. i wana receive some inormation about freckles and melasma.i m 30 years older woman. i m geting merry inside nxt month. plz tell me how i could remove these fracklles from my chiks. i m much worrieds. Regards …..

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