• 28 Mar, 2017
  • Skin disorder Solutions

Also referred to as chloasma or "mask of pregnancy," melasma (A) is a brown darkening of facial skin. Melasma likely occurs from a combination of factors, including exposure to sunlight and an increase in the female hormones estrogen and progesterone.

Melasma is very common in women who take oral contraceptives, hormone therapy or who are pregnant. The dark patches usually occur on the cheeks, forehead, nose and chin. They may or may not resolve after discontinuing the contraceptives or hormone therapy or at the end of the pregnancy.

Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

Who gets melasma?
Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.

What causes melasma?
The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop melasma themselves. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called chloasma, or the "mask of pregnancy." Birth control pills may also cause melasma, however, hormone replacement therapy used after menopause has not been shown to cause the condition.

Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes in the skin. People with dark skin color have more active melanocytes than those with light skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.

Any irritation of the skin may cause an increase in pigmentation in dark-skinned individuals, which may also worsen melasma. Melasma is not associated with any internal diseases or organ malfunction.

How is melasma diagnosed?
Because melasma is common, and has a characteristic appearance on the face, most patients can be diagnosed simply by a skin examination. Occasionally a skin biopsy is necessary to differentiate melasma from other conditions.

How is it treated?
While there is no cure for melasma, many treatments have been developed. Melasma may disappear after pregnancy, it may remain for many years, or a lifetime.

Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as this may worsen the melasma. If melasma develops after starting birth control pills, it may improve after discontinuing them. Melasma can be treated with bleaching creams while continuing the birth control pills.

At EMC, a variety of topical treatment are available for the treatment of melasma. These creams do not "bleach" the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells.

Normally, it takes about three months to substantially improve melasma. Different combination formulas containing tretinoin, steroids, and glycolic acid are available in combination with hydroquinone to enhance the depigmenting effect.

Other treatment programs like different type of chemical peels have been found to help melasma. It is important to follow the directions of your dermatologist carefully in order to get the maximum benefit from your treatment regimen and to avoid irritation and other side effects. Remember, a sunscreen should be applied daily in addition to the treatment. Some topical creams are combined with a sunscreen.

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