Melasma: Causes, Symptoms, and Medical Treatment

The development of hyperpigmented spots or patches on the skin is known as melasma. It occurs as a result of increased melanin production in some areas of the skin, giving those areas a darker appearance.

Several factors contribute to the overproduction of melanin, making melasma a common skin problem, affecting around 5 million people in the United States. (1) Fortunately, multiple treatments are available for fading melasma spots, giving the skin an even tone.

Causes of Melasma

The exact cause of melasma development is not known, but the following factors are seen to affect the rate of melanin production by the melanocytes, thus leading to the formation of melasma spots: (2)

1. Excessive sun exposure

The harmful UV rays in sunlight can increase oxidative stress and can damage the DNA. This causes photoaging and the development of melasma spots. Thus, it is vital to apply sunscreens.

2. Exposure to harmful light

Besides the UV rays from the sun, the light from radiation lamps and tanning beds can also contribute to melasma formation. Moreover, the blue light emitted by electronic devices can exacerbate the condition.

3. Hormonal changes

The hormonal fluctuation of estrogen and progesterone can trigger melasma development. This condition is highly common among pregnant women in their second and third trimesters and is known as chloasma or the “mask of pregnancy.”

Those undergoing hormone replacement therapy or using intrauterine devices, implants, or birth control pills may also develop melasma.

4. Stress

Psychological stress can result in the onset or worsening of melasma. (3)

5. Thyroid problems

People with thyroid disorders are highly prone to the development of melasma.

6. Medications

Medications such as antiseizure drugs and tetracycline (4) can also contribute to melasma.

Signs and Symptoms of Melasma

Melasma presents as grayish-brown patches, generally distributed symmetrically on the face. It is common for people to mistake melasma for age spots or freckles. However, melasma spots are large, dark, and flat with an irregular boundary.

Melasma can be categorized into dermal, epidermal, and mixed types, according to the melanin levels.

Melasma patches generally appear on the:

Medical Treatment for Melasma

Melasma patches are highly asymptomatic and generally do not require treatment.

Chloasma spots gradually fade away after pregnancy. Melasma caused by the use of birth control pills or hormone replacement therapy may fade once you stop taking the medications.

However, you can consult your doctor for the following treatment options if you are bothered by the appearance of your melasma:

• Lightening creams. These may contain tretinoin, hydroquinone, corticosteroids, glycolic acid, or azelaic acid, which helps lighten the spots.
• Tranexamic acid. This is an oral medication that helps inhibit prostaglandin synthesis, thus preventing melasma.
• Medical procedures. Your doctor may suggest different procedures such as chemical peels, dermabrasion, microdermabrasion, intense pulsed light therapy (IPL) and Q-switch laser, or other light-based procedures for fading the spots.

Your doctor may use the Melasma Area and Severity Index (MASI) and serial photography to track the treatment progress.

It is important to note that melasma spots treated with IPL may recur quickly. (5) It can also increase the risk of melasma exacerbation. Therefore, it is best to use topical creams together with other medical procedures rather than light therapy.

Diagnosing Melasma

Melasma can be quickly diagnosed with a physical examination of the affected areas. Your doctor may conduct the following tests to confirm the diagnosis and determine the appropriate treatment:

Risk Factors for Melasma

The following factors can increase the risk of developing melasma:

• Female gender (2)
• Brown skin tone or skin that tans easily
• Tropical climate
• Use of scented toiletries, cosmetics, perfumed soaps, and other such products
• Family history of melasma

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When to See a Doctor

Melasma is generally harmless and therefore, doesn’t require treatment. However, the appearance of melasma patches on the skin can impact a person’s psychological well-being and trigger depression, anxiety, (3) social withdrawal, and low self-esteem. (6)

Therefore, you must consult a doctor if you are bothered about your melasma patches.

Final Word

Melasma refers to the appearance of dark brown patches on the skin, commonly known as hyperpigmentation. It is generally caused by sun exposure and hormonal changes.

Melasma doesn’t pose any threat to your health, but various treatment modalities can help fade the spots. You can consult a doctor if the melasma spots do not fade with time or spread.

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