Symptoms are the same in men and women, however around 90% of cases occur in women.
Women of light brown skin types from areas of the world with intense sun exposure tend to be affected more than others. The actual cause of melasma is unknown, but it is known to be related to both hormonal levels and exposure to sunlight. The condition is harmless, but many people with melasma feel self-conscious about the blotches and are dissatisfied with their appearance. In this animation, you will learn the basics of how melasma arises and ways to improve your symptoms or possibly prevent melasma from forming.
Melasma is simply an excessive accumulation of melanin, your skin’s natural pigment, in the skin. People with a family history of melasma are more likely to develop the condition than others. Melasma commonly arises with hormonal changes that occur during pregnancy, and the term chloasma is used synonymously with melasma for the condition among pregnant women. This onset of melasma often disappears shortly after childbirth, but it may remain for months, years, or a lifetime. Melasma is also known to arise among women taking hormonal birth control pills, and it sometimes occurs in women taking progesterone hormone replacement therapies following menopause. Certain medications as well as facial cleansers, creams, and types of makeup that irritate the skin may cause or worsen melasma.
Your skin is made of two primary layers; the epidermis is the surface, and the dermis lies beneath it. Located near the base of the epidermis are specialized cells, called melanocytes, which produce the pigment melanin. Melanin gives your skin its normal color, and it is transported into new skin cells where it serves a protective role by absorbing harmful rays of sunlight that would otherwise damage the cells. When melasma occurs, melanocytes in certain areas overproduce melanin. As accumulating melanin gradually becomes more visible, the characteristic patches occur. The excessive melanin typically exists near the base of the epidermis, and appears as tan or brown blotches. However, the pigment may also be associated with cells near the top and mid-dermis, in which case, blotches can appear from light brown to bluish black.
Melasma tends to worsen with increased sun exposure. The best method for preventing melasma from forming, worsening, or recurring is strict sun avoidance. Daily use of a broad spectrum sunscreen of SPF 30 or greater that blocks both the UVA and UVB forms of light is recommended. Sunscreens that use metallic compounds, such as titanium oxide or zinc oxide, to block, rather than absorb ultraviolet light may be the most effective when spending time outdoors. Full-length clothes and a wide brimmed hat also help minimize sun exposure. It is paramount to strictly avoid sun exposure, even following treatment, because even incidental sun exposure may cause a recurrence. If possible, discontinuing certain medications, cleansers, creams, or makeup suspected of irritating your skin or making your melasma worse may improve your symptoms. If melasma is caused by the birth control pill, discontinuing the pill may cause it to clear and prevent future occurrence. When discontinuing a certain product, it’s important to keep in mind that just as melasma tends to arise gradually, it also tends to clear very gradually.
Melasma cannot be cured permanently, but various treatments options may help clear the patches. The principal treatments are topical depigmenting creams containing hydroquinone, which decreases the activity of melanocytes without destroying them. Azelaic acid is also used topically, and is believed to inhibit melanin production in overactive melanocytes. For people who aren’t pregnant, topical treatments with tretinoin are sometimes used. Trentinoin is believed to increase the turnover of cells that accumulate excess melanin, thus allowing pigment to be cleared as the cells die. Other treatments, including chemical peels and laser treatments, are used by some skin care professionals to physically remove the pigment. These treatments are often used in conjunction with topical treatments. Keep in mind that treating melasma can take several months, and some treatments will work better for certain people than others. Discuss your specific situation with a skin care professional to find the treatment option that will be the safest and most effective method for you.