Melasma: Causes, Treatments, and More
Melasma is a chronic condition that creates hyperpigmentation of the skin. What this means is that areas of the skin become darker in color. The most visible symptom of melasma is the appearance of irregular brown or gray patches that appear on the body, and typically on those body parts that receive the most exposure to sunlight and UV rays. While sun exposure has been linked as a trigger for melasma, its exact causes and preconditions are unknown, having also been linked to hormonal and other environmental stressors.
While wrinkles, acne, and scarring are some of the most well-known skin ailments, other skin conditions like hyperpigmentation are just as common, yet less frequently discussed. In particular, melasma is a common skin problem known to affect mostly women and those with darker skin types. The largest concern for people with this skin disorder is the adverse effect it has on the appearance. In melasma cases, the condition causes skin color patches to show up in brown, grey, or gray-brown spots on various areas of the body. In 50-80% of cases, melasma appears in a centrofacial pattern over the cheeks, forehead, nose, upper lip, and chin.
If you currently suffer from melasma or are genetically predisposed to the condition, you’re likely to be aware of the symptoms of this type of hyperpigmentation causes to the skin—as well as the dramatic effects it can have on one's’ appearance and self-esteem. In this article, find out more about this very common skin condition, and what those that have it can do to reduce or eliminate melasma spots using some of today’s most advanced cosmetic dermatology procedures.
Melasma is a chronic condition that creates hyperpigmentation of the skin. Inflammation of the skin, whether from extreme cold or sun exposure can cause an outbreak or worsen the symptoms. Due to the effects on the skin’s appearance, this condition puts forth great amounts of psychological and emotional distress on a person, which can effectively lower the self-esteem. This can lead to depression, anxiety, and general mental anguish for a great many of those that struggle with this condition, of which up to 90% are women.
Melasma can affect one or many areas of your body and can be exacerbated by hormonal changes in the body, including pregnancy. Melasma is commonly referred to as the “mask of pregnancy” because of its frequent appearance in pregnant women. While the exact cause of melasma in pregnant women is unknown, it’s thought to be triggered by the surge of hormones in the body that are present during pregnancy.
The most common locations of the body where melasma breakouts appear is the face, as well as the arms and shoulders, chest, back, and neck areas, or wherever the skin is most frequently exposed to the sun. The face is usually the most affected by melasma and can appear in spots as benign as freckles, to large, dark patches over the center of the face. The most common areas of the face affected by melasma are the cheeks, forehead, nose, and upper lip areas.
One thing to keep in mind with these patches is that they are usually symmetrical in appearance. This means that one patch on one cheek will match a patch on the other cheek. Also, when melasma occurs on the body, it usually appears on the forearms, neck, hands, and anywhere else the sun is in frequent contact with the skin. During the summertime or in hot weather, melasma can also appear in other areas usually covered by clothing, which is why those with this condition are encouraged to wear hats, long-sleeved shirts, pants, and other protective clothing, and to apply sunscreen consistently throughout the day when in contact with the sun.
What Causes Melasma and Who Gets It?
As mentioned before, people with brown skin or darker skin tones are most likely to get melasma. This is because the melanocytes in the skin (color-making cells) respond to solar damage and sun exposure by producing more color. Because people of color have more active melanocytes, to begin with, they’re more likely to experience melasma after sun exposure.
People of Latin/Hispanic, African, Asian, Indian, Middle Eastern, and Mediterranean backgrounds are most susceptible to melasma symptoms. Additionally, the likelihood of developing melasma is even greater if you have direct family members who had or have melasma as well.
Those that spend more time in the sun without proper sun protection are also at a higher risk of developing melasma since excessive sun exposure is a common trigger for the condition. The UVA/UVB rays stimulate the melanocytes in the skin causing the changes in pigmentation. Even a small amount of sun exposure can cause melasma to reappear after fading. Limiting sun exposure is key to the overall maintenance of the condition for those that suffer from it.
As mentioned before, females are also at a higher risk than males for melasma. This is largely thought to be due to hormonal changes that occur more often in women than in men, though exact causes of melasma are still largely unknown. In any case, researchers have explored various correlations between women and melasma during high-hormone level conditions like pregnancy, during hormone replacement treatments, with conditions like thyroid disease, and after taking birth control pills and oral contraceptives.
Melasma Treatments: Lasers, Creams, and Home Remedies
Melasma is largely treatable in most circumstances. If you have melasma, your board-certified dermatologist or cosmetic surgeon can determine the best course of treatment to meet your needs after a thorough evaluation. Your treatment options depend on the nature of your melasma and how well you respond to certain factors. Since the exact cause of melasma is unknown, but triggers have been identified that cause melasma to appear or worsen, working with your doctor is the first step when considering the treatments below.
Laser Resurfacing: Laser resurfacing is designed to reduce wrinkles, scars, and most importantly for melasma patients, irregular skin discolorations. Using a non-ablative or ablative laser, layers of skin are removed to help the brown patches fade away. One concern for patients of this procedure is the delicate nature of using the laser to not only do away with the skin discoloration but also that the resulting skin tone is uniform with the rest of the face.
Light Therapy: While UV light is a trigger for melasma, it may seem counterproductive to combat the effects of solar damage with light therapy. This option uses LED light to enhance the condition of the skin while eliminating minor skin flaws. However, LED light therapy is designed to be a supplement to other more aggressive cosmetic skin treatments and not a standalone remedy by itself. That being said, yellow light is one of the newer options and is being used specifically for melasma as well as other similar conditions. Red light is also an option to consider with this therapy.
Chemical Peels: Chemical peels work to exfoliate and peel away layers of damaged and overly pigmented skin. There are varying depths of peels to achieve desired results. It should also be noted that in some cases, hyperpigmentation can worsen or be triggered with chemical peel treatments. Ask your doctor whether this option is right for you.
Microdermabrasion and Dermabrasion: These techniques are reported to help treat brown spots and uneven pigmentation on outer layers of the skin. The main goal is to stimulate cell regeneration to combat the dark spots by removing layers of the skin through aggressive exfoliation. Dermabrasion is much more invasive than microdermabrasion, which tends to offer less dramatic results—especially in the treatment for melasma.
Products & Topical Medications for Melasma
Triple creams, which are made with three active medicines: tretinoin, corticosteroid, and hydroquinone have shown to be highly effective in treating melasma. Some studies show potential side effects associated with the long-term use of hydroquinone, however, which is why scientists continue to search for other solutions that carry lower risks for complications.
Other topical medications used for the treatment of melasma include salicylic acid, tranexamic acid, glycolic acid, azelaic acid or kojic acid, arbutin, and ascorbic acid—which have all been known to lighten skin patches and symptoms of melasma. In general, however, these products have been shown to have a better effect as a preventative measure instead of as a restorative measure.
For example, an over-the-counter cream with a high, broad-spectrum sunscreen of SPF 30 or higher can work well to protect the skin against solar damage that leads to melasma spots and other adverse conditions, like skin cancer. Unfortunately, once the skin has been damaged, it’s impossible to reverse the damage without the application of more aggressive treatments like laser treatments for resurfacing the skin, or dermabrasion.
In some cases, creams can also be a detriment to melasma. This can happen during the application of a product, where the constant rubbing of melasma patches can inflame the skin (and even cause post-inflammatory hyperpigmentation), therefore making the spots worse.
Melasma is a very common skin condition in the United States that affects only the aesthetic appearance of the skin. Aside from the aesthetic issues it causes, it is otherwise quite harmless and will not put your overall health in jeopardy. Even so, the symptoms of melasma can be quite bothersome for those affected by its appearance, which can cause plenty of stress and emotional issues that can quickly become serious.
The good news is that melasma can be treated with a variety of cosmetic procedure solutions, and can also be prevented in those that have a higher risk of an outbreak. For the best outcome, make sure to find a reputable doctor recommended by the American Society of Plastic Surgeons, the American Academy of Dermatology, or the American Board of Dermatology, that can diagnose melasma and provide you with the professional care you need to relieve you of your symptoms short-term and in the long-term.
In any case, people with melasma or that have a high risk of developing melasma should take great care to limit their exposure to the sun. If you do have to go outside during daylight hours, be sure to use a broad-spectrum sunscreen, a wide-brimmed hat, and to take other protective measures to reduce the effects of solar damage on your skin.