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What is melasma?

Melasma is a common and frustrating skin condition of hyperpigmentation. It is also known as chloasma, or the mask of pregnancy. It presents as symmetrical, blotchy brown to gray-brown patches, most commonly on the face and neck. Melasma affects more than 5 million people in the United States alone. Found more commonly in women with darker skins tones, it is especially prevalent in those of Hispanic, Southeast Asian, African, Indian, Mediterranean, and Middle Eastern backgrounds. People living in areas of intense ultraviolet light are at higher risk for melasma. Although melasma is not harmful, it is often a challenge to treat and can have a negative effect on one’s quality of life. Because of these detrimental social and psychological effects, it is important to seek proper treatment.

What causes melasma?

Melasma is caused by an increased activity of the pigment-producing cells of the skin (melanocytes), resulting in more pigment deposition. The exact cause of melasma is unclear. However, a common inciting factor is exposure to sunlight, which is thought to activate the melanocytes to produce more pigment. Hormones are also thought to play a role, but the exact link between hormones and melasma has not been clarified. Nevertheless, circumstances that affect hormones, like pregnancy, oral contraceptives, and hormone replacement therapy, can contribute to the development of melasma. Genetic factors also seem to play a role with some studies showing a higher incidence among family members. Less common risk factors include thyroid disorders, phototoxic medications, and cosmetics.

Melasma treatment options

Treatment of melasma often requires multiple therapies in combination. Improvement occurs over the span of several months. Reducing exposure to sunlight and applying sunscreen daily is often a critical step. When outside, avoiding direct sunlight by wearing a wide-brim hat or other protective clothing is more effective than sunscreen alone. One should use a high-factor broad-spectrum sunscreen that has good protection against UVA light. Furthermore, sunscreens with protection against visible light may provide additional benefit. This will help to reduce the production of more pigment.

Topical retinoids and glycolic acid peels can be used to increase the elimination of pigment already present. Topical depigmenting agents like azelaic acid or hydroquinone are useful, often in combination with a retinoid and a topical steroid. Other topical options include kojic acid and niacinamide. Laser therapies work by targeting the pigment in the skin. However, results are mixed. Tranexamic acid can be used topically or orally to prevent activation of the factors that stimulate pigment producing melanocytes. For women who experience the onset of melasma after starting an oral contraceptive, the medication should be stopped if possible. Pregnancy-induced melasma may improve postpartum. Effective treatment of melasma often requires a combination of many of these therapies. Each patient is unique and should visit a board-certified dermatologist to determine which therapies are right for them.

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