Melasma is usually found on sun-exposed areas of skin such as the cheeks, upper lip, chin, and forehead. When melasma occurs during pregnancy, it is sometimes called chloasma.
What is melasma?
Melasma is an area of hypermelanosis, which means more melanin pigmentation (brown or tan skin colour) than other areas. It seems to be related to hormones in women, but it can also occur in men.
The hormone link
We’re not sure why melasma occurs, but it does occur more in pregnant women and women who are on oral contraceptives. It may be in areas where there are more oestrogen receptors. Hormone-related melasma in men is still being debated.
Who gets melasma?
Anyone can be affected by melasma, but it’s much more common in people with darker skin, particularly those with lighter-brown skin like Asians and Latinos, who may also come from areas of the world with lots of sun.
It is more common in women – in fact 90 per cent of all cases are in women, with most being in their reproductive years.
What can trigger melasma?
Pregnancy and the pill, as noted, but also some photosensitising medicines, some cosmetics, and mild ovarian or thyroid dysfunction. The key to development of melasma is exposure to sunlight. UV rays increase production of certain hormones in the skin which can contribute to increased melanin production.
The first step is avoiding sun exposure, since any treatments rely on not triggering the problem again. Successfully treating melasma depends on which layer of the skin – dermal or epidermal – the pigment is within, since the dermal layer is much more difficult to treat than the epidermal layer. The epidermis is the top layer of skin, with the dermis sitting beneath. The pigment actually comes from the epidermis, so dermal melasma – while not able to be directly treated most of the time – can be prevented from worsening, and faded over time, by treating the epidermis.
Treating melasma needs to be done carefully by a professional with experience, since a wrong move and you can make the pigmentation worse. Some melasma contains blood vessels that must also be treated.
Treatments are a long-term commitment and there are no quick fixes, but we do have the best tools available to get optimal results.
Our treatment approaches include:
- Topical vitamin C and bleaching preparations
- Stopping the combined oral contraceptive pill (COCP)
- Anti-inflammatory agents
- Low-energy wave-based therapies (like lasers)