Melasma

Melasma is a common skin condition characterized by dark, discolored patches on the skin, often appearing on the face, particularly the cheeks, forehead, nose, and upper lip. It’s more prevalent in women, although the men can be affected as well . In young women, it can occur during pregnancy (often called the “mask of pregnancy”), and is linked to hormonal changes, sun exposure, and genetic predisposition.

Causes of Melasma:

Hormonal Changes: Birth control pills, pregnancy, and hormone replacement therapy can cause melasma.
Sun Exposure: UV rays encourage the production of melanin, worsening melasma. However, latest studies show that infrared light ( IR light), blue light and high intensity visible light can also increase melanin production in the skin. Melasma skin on histopathology shows changes of photoageing - disruptions in continuity of basement membrane, moderate solar elastosis, new blood vessel formation (angiogenesis), and mast cells seen in the dermal layer. That indicates melasma can be due to excessive sun exposure.
Genetics: A family history of melasma can increase your risk of getting melasma. Asians and Hispanics are more prone to developing melasma.
Skin Care Products: Certain products that irritate the skin may make melasma worse. Some treatments used for melasma in the earlier days, like steroids, Kigmans formula can cause rebound, hyperpigmentation after stopping the treatment.

Treatment Options:

1. Sun Protection: Daily use of broad-spectrum sunscreen with SPF 50 or higher is crucial. Mineral sunscreens with tint can give camouflage as well as a broad spectrum coverage. Physical sunscreens with iron oxide, large size zinc oxide or titanium dioxide provide effective protection against both visible light and uv light. Even infrared light (IR light) protection is desirable in patients with melasma as some patients spend a significant time in the kitchen.

2. Topical Treatments:

Hydroquinone: A skin-lightening agent often considered the first-line treatment for melasma. 2-8% concentration is used either alone or with other skin lightening ingredients. However It can irritate the skin in certain patients, it may also cause ochronosis, a known complication where skin turns bluish grey to dark back, after usage, in some patients.
Tretinoin and Corticosteroids: Often used in combination with hydroquinone to enhance skin lightening. Many popular combinations including these drugs are used in Kligman's formula and modified Kligman's regimens. However, these treatments give a short benefit. The long term usage can make the skin very sensitive and thin.
Azelaic Acid: Reduces pigmentation and is often used as an alternative to hydroquinone. It is a safe drug even in pregnant women.
Tranexamic Acid: Can be used topically or orally (under a doctor’s supervision) to reduce pigmentation.

3. Chemical Peels: Peels with glycolic acid or salicylic acid can help lighten melasma over time.

4. Laser Treatments and Light Therapy: These treatments can target pigmentation but should be done cautiously, as they can sometimes worsen melasma.

5. Microneedling: This procedure can improve melasma by promoting collagen production and helping topical treatments penetrate more effectively.
Lifestyle Tips:

Avoid Triggers: Protect your skin from UV exposure, avoid hot environments that can worsen melasma, and use gentle skin care products.
Consistent Skincare Routine: Maintaining a consistent regimen with products that target pigmentation can help manage melasma.

Melasma can be stubborn and recurrent, so ongoing maintenance and regular dermatologist consultations are essential for effective management.