Melasma

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How common is melasma?

  • It is quite common. Between 15 and 50% of pregnant women will get melasma, and up to 33% of the population will develop melasma in their lifetime. .
  • It is prevalent in darker skinned women, but men can get melasma too.
Melasma

What causes melasma?

  • Melasma is a complex, multifactorial condition that occurs due to an overproduction of the cells that make the colour of your skin.
  • It is common and harmless and often fades after pregnancy, but in other instances it is often chronic.
    Factors that cause melasma include
  • Sun exposure which promotes melanin production
  • Hormones – pregnancy, contraceptive pills, HRT and intrauterine devices are involved in 25% of women with melasma (oestrogen and progesterone are the culprits)
  • Thyroid disorders
  • Some targeted cancer therapies
  • Some perfumed soaps and cosmetics
  • Tanning beds

  • Some anti-seizure medications

  • LED screen light from computers and laptops and phones

What are the patterns of melasma?

  • Centrofacial melasma – forehead, cheeks, nose, upper lip – the majority of cases
  • Malar melasma – the cheeks and nose
  • Mandibular melasma – jawline, chin .

What are the three types of melasma?

  • Epidermal melasma has a well-defined border; is dark brown with scattered islands of brown with a fine reticular structure (netlike)
  • It usually has a reasonable response to treatment and under the dermatologist light it appears more obvious.
    Dermal melasma has an ill-defined border; is light brown to glue-grey and usually has a poor response.
  • Mixed melasma is the most common type and usually manifests as a combination of blue-grey, light and dark brown, with mixed patterns under the dermatoscope and Wood lamp. Treatment often shows partial improvement.

     

How is melasma diagnosed?

  • Dr Parisa will examine your skin with a special tool called a dermatoscope and the diagnosis will be made on the clinical appearance of your skin under the guidance of this tool.
  • She may also take a skin biopsy to rule out other conditions commonly confused with melasma including lichen planus (itchy skin rash), medication induced pigmentation, guttate hypomelanosis (small, flat white sunspots), age spots, nevus of Hora (blue grey spots around the eyes common in Asians) and Nevus of Ota (another eye condition that causes brown blue hyperpigmentation of the eye and increases risk of glaucoma).

What is the treatment for melaasma?

  • Treatment of melasma is difficult and a combination treatment is best approach including sun protection,topical skin lightening creams,oral tablet,and laser.
  • Year round, life-long sun protection is advised (hat, glasses, sunglasses, sunscreen and SunSmart App)
    As there is a hormonal component many pregnant women will see their melasma get lighter after pregnancy, while hormonal contraceptives and HRT can be discontinued to help resolve hormonal melasma.
  • Dermatologist prescribed hydroquinone, tretinoin and gentle skin lightening creams are the mainstay of treatment and can reduce discolouration.
  • Chemical peels and lasers can help to improve melasma however sometimes it makes the melasma worse if you don’t practice sun protection for six months after these treatments.
  • Oral medication such as tranexamic tablets is an off-label treatment for melasma. It may be prescribed by your dermatologist.
  • A skin friendly diet with Vitamin D is advised.
  • For the patients living with this chronic, embarrassing and bothersome condition, when treated well, quality of life is significantly improved.

Melasma v sunspots what’s the difference?

  • Outside of a dermatologist examination, it can be hard for the layperson to tell the difference between melasma and garden variety sunspots.
  • Both are aggravated by sun exposure and both cause dark patches on the skin.
  • Melasma often worsens in hormonal periods (puberty, “the mask of pregnancy” and menopause), while sun spots can turn up any old time.
  • “However, melasma tends to be symmetrical and bilateral (both sides of face) in its appearance while sun spots aren’t necessarily,” says Dr Parisa.
Sources
DermNet – Melasma
Warning on OTC skin lightening creams
Cleveland Clinic – Melasma Diagnosis and Treatment
Melasma and Thyroid Disease: A systematic review and Meta Analysis, 2019