Melasma is a skin condition that can affect both sexes but is more common in women. Pregnant women are more likely to suffer from it, so it is considered one of the pregnancy traits. It causes a skin rash with unequal borders and a dark color to appear on the face, where it can be found on the cheeks, forehead, nose or lips. It is symmetrical and affects both halves of the face. Another area that can be affected by the rash is on the upper arms. It causes the skin to lose its natural color and become grey or brown.

All races and both sexes can be affected by melasma. However, it is a lot more obvious for people with darker skin such as Africans, Arabs, Asians or Hispanics. For the same reason, it is more visible on the skin of people who spend a lot of time in the sun and have a higher level of melanin. Melasma sometimes goes unnoticed on individuals with a lighter skin tone.

What are the symptoms of melasma?

The condition causes some patches of skin to become darker than normal. Typical for melasma is the symmetrical pattern of the rash, with patches on both sides in mirror-like fashion. It is usually found on the face but can affect any part of the body that gets constant sun exposure, such as the neck or upper arms.

The most vulnerable areas are usually the cheeks, bridge of the nose, chin and forehead. The rash found in this area is typically dark brown. Other parts of the upper body, like the forearms and neck, can also be affected. The condition is not a serious health concern but the patches are hard to tolerate for cosmetic reasons, especially the ones on the face.

Even if melasma is not a dangerous condition, you should always ask for medical advice. A dermatologist, who is a doctor specialized in skin issues, can provide the best treatment.

What causes melasma?

Scientists have been unable to identify the exact cause of melasma. There appears to be a genetic link, since it tends to run in the same families. Because it is the most common during pregnancy, which is a period of severe hormonal changes, it might be caused by a hormonal disorder. It is also known as the mask of pregnancy, or chloasma. Women who take birth control pills have a higher risk but the hormone pills taken after menopause don't seem to have any impact on the disease.

Melasma is known to be influenced by sun exposure. The normal skin defence mechanism against UV light is to activate the production of melanin from specialized cells named melanocytes. Everyone has the same amount of melanocytes but they are more active on individuals with dark skin. Exposure to light and certain hormonal changes can stimulate these cells to produce a lot more pigment than normal. Scientists now suspect that melasma is directly caused by sun exposure, which seems to reactivate the disease.

The condition sometimes becomes worse as a result of skin irritation, which causes the skin of dark-skinned people to become even darker. The good news is that this disease is not linked with any more serious problem or condition.

Treatment options

While the disease itself can't be cured, several treatments for melasma have been developed. The usual method is to remove the skin completely, using a chemical peeling agent. These agents are usually acid fruit extracts or chemical ones such as azelaic acid, glycolic acid, lactic acid or trichloroacetic acid. The stronger a peeling acid is, the more effective it can be against melasma. However, strong ones must be used with caution, since they can have serious side effects such as permanent skin discoloration, scarring, burning or wounds.

Hydroquinone is one of the most effective of the many products available for skin bleaching. These products are widespread and some of them can be found in nutrition shops or herbal stores, besides pharmacies. Their effect depends on the agent used and the particular skin of every person, which can react more or less favourably.

Sunscreen products based on a content of minerals like titanium or zinc are another possible treatment, as well as rejuvenating the skin through laser therapy.

These treatment can be more or less effective, depending on the patient. They don't cure the root cause of the disease and can have side effects. Sometimes, a mix of several treatments is needed for best results. In most cases, the color of the skin is improved but doesn't completely return to normal. Some of these treatments must be followed for a long time, in particular the use of skin bleaching products. Sun exposure should be avoided during treatment and the skin must be protected with quality sunscreen lotions or creams.

Melasma seems to become worse after sun exposure. To prevent it, use sunscreen with a protection factor of 20 or more and choose products based on minerals. It is also advised to protect your skin with proper clothes and a hat. Women can also use makeup, which not only hides the condition but can also act as a shield against UV radiation.

When melasma is caused by a hormonal imbalance such as pregnancy or birth control pills, it usually disappears after a while without any treatment.

If treatment is required, doctors can choose between several options. The skin can be lightened using topical prescription steroids or skin lightening creams. Dermabrasion or microdermabrasion can also treat the problem in more complicated cases, by completely removing the top layer of skin and forcing it to regenerate.

However, there is no guarantee that the condition doesn't return or that it is completely removed. The risk of a new outbreak can be reduced through treatment. However, avoiding sun exposure and applying generous amounts of sunscreen might be the best methods to prevent it.