Melasma causes irregularly sized brown or gray patches on the face, mainly in women who are pregnant, taking birth control pills, or using hormone replacement therapy. It can also occur in lighter-skinned people of both sexes due to genetic predisposition, thyroid dysfunction, or allergic reactions. Hydroquinone and Tretinoin can reduce the appearance of the condition, while facial peels and laser surgery are options for persistent forms. Sun exposure can make the condition worse, so limited sun exposure and sunscreen are recommended.
Melasma usually occurs when estrogen and/or progesterone stimulate pigmentation hormones, causing irregularly sized brown or gray patches on the face. The condition, also called chloasma or pregnancy mask, occurs more frequently in darker-skinned women, but can also occur in lighter-skinned people of both sexes.
Melasma is mainly found among women who are pregnant, taking birth control pills or using hormone replacement therapy. In general, the spots on the skin appear over time and may look like small moles at first. The patches are found on the cheeks, forehead and nose and their irregular shape indicates the condition. When a pregnancy ends or hormone treatment is stopped, the patches usually disappear within a few months.
Although darker-skinned women are primarily predisposed to the condition, others may also be prone to melasma. Genetic predisposition can make a person more susceptible to this condition, and thyroid dysfunction can also increase susceptibility. Allergic reactions to medications or cosmetics and, in some cases, stress can produce the condition. While commonly thought of as a “female” disease, this condition is sometimes found in men, particularly those of Central American or Latino ancestry. The main indicators in men are ancestry, exposure to sunlight and family history.
Under a Wood’s lamp, melasma is easily diagnosed. The lamp allows you to see excess melanin in the skin and distinguish it from normal skin cells. Doctors may not need a Wood’s lamp for diagnosis, particularly if the patient is pregnant or taking estrogen or progesterone supplements. If the patient is not pregnant or taking hormones, a closer examination, including blood tests, may be done to rule out lupus, which can cause a “butterfly” pattern on the nose, forehead, and cheeks.
Other than the marks on the face, melasma causes no other physical conditions, and the condition usually resolves on its own without treatment. However, hydroquinone, a skin cream available by prescription or over the counter, has skin-whitening properties that can reduce the appearance of the condition. Another skin lotion, Tretinoin or Retin-A, increases the acidity of the skin so new skin cells develop more quickly. This treatment cannot be used during pregnancy as it is considered dangerous for the fetus.
Other treatments, including facial peels and laser surgery, are generally considered an option for people with persistent forms of the condition. Under no circumstances will patches fix immediately. All treatments produce gradual results.
Anyone suffering from melasma should take extra care outdoors. Sun exposure can make the condition worse, and when combined with medications such as tretinoin, can further dry out the skin. Limited sun exposure is recommended, but if sun exposure is unavoidable, sunscreen that blocks both UVA and UVB rays should always be worn.
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