Understanding melasma in women

The common skin condition known as melasma, is one of the most frustrating conditions to treat.  Described as dark patches of pigment that lie in the upper epidermis or mid layer (dermis) of the skin, melasma commonly appears on the face but it can appear on other parts of the body frequently exposed to the sun such as the forearms and neck.  

Women are far more likely than men to get melasma. This is according to the American Academy of Dermatology, which shows that 90 percent or 6 million people who develop melasma are women.

What is melasma?

Also known as chloasma or the ‘mask of pregnancy,’ melasma typically makes its first appearance in women who are pregnant.  A woman will know she has it if she notices patches of discoloration that are darker than her normal skin color.  These patches usually appear on the face (cheeks, forehead, bridge of the nose, and chin) and are symmetrical with matching marks on both sides of the face. Other than causing uneven, darker colored skin patches making a person feel self-conscious about it, there is no physical harm caused by melasma.

Causes, risk factors and why do women get it more frequently?

It is not entirely certain what the cause of melasma is but individuals with naturally darker skin, such as Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, or Mediterranean descent, are more at risk than individuals who are fair skinned.  Melanocytes are the color-making cells in the skin that produce color.  It is believed that people with skin of color are more prone to melasma because they have more active melanocytes that can produce too much color than people with light skin. 

Sun exposure is another common trigger for melasma.  Ultraviolet (UV) light from the sun stimulated the melanocytes and even after melasma may fade, just a small amount of sun exposure can make it return again.  Summer is when melasma often gets worse due to more frequent and longer exposure of bare skin to the sun.  

Another factor is hormonal sensitivity involvement due to estrogen and progesterone that has been associated with this skin condition.  For women, this means using birth control pills, pregnancy, and hormone therapy can all be triggers for melasma. 

Other causes could be stress, thyroid disease or just being around heat such as when cooking, may make some women prone because of heat’s ability to irritate the skin resulting in an overproduction of pigment.

Treating melasma

Even though there is no known cure, melasma can be effectively treated.  Sometimes it may eventually fade on its own particularly if the trigger causing it such as when pregnancy or oral contraceptive use ends.  But if and when that may or may not happen, there are certain treatments one can try to help at least minimize or fade this darkened appearance.

·      See a dermatologist

To definitively diagnosis the skin condition, a visit with a dermatologist is advisable.  They can view the extent of melasma and make recommendations on how to treat it through prescribing certain medications or in-office treatments and will provide tips on limiting sun exposure in order to prevent further damage.

·      Hydroquinone

Available in a cream, lotion, gel, or liquid, this medication works by lightening the skin.  Hydroquinone can be found in over-the-counter preparations, but stronger strength versions can only be obtained through a doctor’s prescription.

·      Tretinon and corticosteroids

These medications enhance the skin lightening process when added to hydroquinone.  Some contain three compounds – hydroguinone, tretinoin, and a corticosteroid, which are then called a “triple cream.”

·      Other topical medications

Also applied to the skin, these may include the skin-lightening azelaic acid or kojic acid.

·      In office procedures

When topical medications don’t do the trick, dermatologist may use in-office procedures such as a chemical peel, microdermabrasion or dermabrasion treatment.  These treatments slough off the top layers of skin, reducing the appearance of the darkened areas.  There can be irritation from these procedures but if they are done in an office overseen by a dermatologist, this will be monitored more closely. 

Most treatments for melasma do result in good outcomes.  Initially, melasma may be stubborn to want to respond to treatments but with diligence and patience in allowing topical treatments to work, most patients are usually very happy with the results.