Melasma: Causes, Symptoms, and Treatment Options

What is Melasma?

Melasma is a common skin condition characterised by brown or grey-brown patches on the face, particularly the cheeks, forehead, nose, and upper lip. It is sometimes referred to as the "mask of pregnancy", as it frequently affects pregnant women. However, melasma can impact anyone, especially those with darker skin tones who are exposed to the sun.

This pigmentation disorder occurs when the colour-making cells in the skin (melanocytes) produce too much colour. The exact cause is unclear, but several factors can trigger melasma, including hormonal changes, sun exposure, and certain medications.

While melasma disease does not cause physical discomfort, many people seek treatment for cosmetic reasons. If you have noticed darkened patches on your skin, it's essential to understand the types, causes, symptoms, and treatment options for melasma.

Types of Melasma

Melasma is classified into three main types based on the depth of the excess pigment in the skin:

• Epidermal melasma: The most common type, where the dark patches are located in the top layer of skin (epidermis). It usually appears dark brown and responds well to treatment.
• Dermal melasma: Occurs when the excess pigment is located in the deeper layer of skin (dermis). The patches appear grey or bluish and are more resistant to treatment.
• Mixed melasma: A combination of both epidermal and dermal melasma, with the pigment present in both layers of the skin.

Your dermatologist can determine the type of melasma you have using a special lamp called a Wood's lamp. Identifying the type helps guide the most effective melasma treatment approach for your skin.

Causes of Melasma

While the exact cause of melasma is unknown, several factors can trigger or worsen this condition:

• Hormonal changes: Pregnancy, oral contraceptives, and hormone replacement therapy can all stimulate melanocytes, leading to melasma.
• Sun exposure: Ultraviolet (UV) light from the sun can increase melanin production, darkening existing patches and causing new ones to form.
• Genetics: Having a family history of melasma increases your risk of developing the condition.
• Skin care products: Certain cosmetics and toiletries can irritate the skin and worsen melasma in some people.

It's important to note that melasma is not contagious or related to an allergy. By identifying and minimising your exposure to these triggers, you can help prevent melasma or keep it from getting worse. Wearing sunscreen daily and avoiding excessive sun exposure are crucial steps in managing this condition.

Symptoms of Melasma

The primary symptom of melasma is the appearance of dark, discoloured patches on the skin. These patches are typically:

• Brown or grey-brown in colour
• Located symmetrically on both sides of the face
• Most commonly found on the cheeks, forehead, nose, chin, and upper lip
• Flat, with an irregular border
• Painless and non-itchy

In some cases, melasma can also appear on other sun-exposed areas like the forearms and neck. The appearance of these patches can vary depending on your skin type and the amount of sun exposure.

Many people with melasma feel self-conscious about their skin's appearance, which can impact their quality of life. If you notice any darkened patches on your face that don't fade on their own, it's best to consult a dermatologist for an accurate diagnosis and personalised melasma treatment plan.

Treatment Options for Melasma

While there is no cure for melasma, several treatment options can help fade the dark patches and improve your skin's appearance:

• Topical medications: Creams containing hydroquinone, tretinoin, corticosteroids, or kojic acid can lighten the skin by reducing melanin production. These melasma treatment creams are often used in combination for best results.
• Chemical peels: Superficial or medium-depth peels using glycolic acid, salicylic acid, or trichloroacetic acid can remove the top layer of skin, promoting cell turnover and reducing pigmentation.
• Laser therapy: Fractional lasers or intense pulsed light (IPL) treatments can target the pigment in the skin, breaking it up for the body to remove naturally. However, laser therapy may not be suitable for all skin types.
• Oral medications: In some cases, your dermatologist may prescribe oral tranexamic acid or glutathione to help reduce melanin production from the inside.
• At-home treatments: Gentle skincare routines, sun protection, and over-the-counter lightening creams can help manage melasma. However, it's essential to use these products under the guidance of a dermatologist to avoid irritation or worsening of the condition.

The most effective melasma treatment often involves a combination of in-office procedures and at-home care. Your dermatologist can create a personalised treatment plan based on your skin type, the severity of your melasma, and your individual needs.

Melasma Home Remedies

Melasma is a common skin condition that appears as brown or grey-brown patches on the face, especially on the forehead, cheeks, and upper lip. While medical treatments are available, the following melasma treatment at home strategies can help manage symptoms and support healthier skin:

• Sun Protection: Consistent sun protection is crucial. Use a broad-spectrum sunscreen with an SPF of 30 or higher every day, even when indoors or during cloudy weather, as UV rays can penetrate windows. Reapply every two hours when outdoors. Additionally, wear a wide-brimmed hat, sunglasses, and protective clothing to shield your skin from direct sunlight, and try to stay in the shade between 10 a.m. and 4 p.m.
• Camouflage Makeup with SPF: Use concealers and foundations specifically designed to cover hyperpigmentation. Opt for makeup products that also contain SPF to add an extra layer of protection against UV exposure while helping even out skin tone temporarily.
• Natural Remedies: Certain natural ingredients like turmeric, aloe vera, and licorice extract are known for their anti-inflammatory and skin-brightening properties. For example, turmeric paste may help reduce pigmentation, aloe vera can soothe irritated skin, and licorice extract may help lighten dark patches. However, these remedies should be used with caution and only after consulting a dermatologist.
• Hydration: Drinking enough water throughout the day helps maintain skin hydration and overall health. Additionally, applying a gentle, non-comedogenic moisturiser twice daily can improve the skin barrier and reduce irritation.
• Gentle Skincare Routine: Avoid skincare products with alcohol, fragrances, or harsh exfoliants. Instead, choose fragrance-free, hypoallergenic products that are designed for sensitive skin. Gentle cleansing and regular moisturising can prevent further irritation and worsening of melasma.

Consistent care and patience are key when using home remedies for melasma.

Can Melasma Be Prevented?

While it may not be possible to completely prevent melasma, there are several steps you can take to minimise your risk of developing the condition or experiencing a flare-up. Since sun exposure is a major contributor to melasma, consistent sun protection is key. In addition to daily sunscreen use, wear protective clothing like long-sleeved shirts and wide-brimmed hats when spending time outdoors.

Hormonal changes, particularly during pregnancy, are another common trigger for melasma. While these changes can't be avoided, managing stress through relaxation techniques like deep breathing, meditation, or yoga may help reduce cortisol levels, which can contribute to melasma.

Certain medications, such as birth control pills and hormone replacement therapy, can also increase the risk of melasma. Talk to your healthcare provider about alternative options if you're concerned about developing the condition.

Making lifestyle changes to support overall skin health may also help prevent melasma. This includes eating a balanced diet rich in fruits, vegetables, and healthy fats, staying hydrated, getting enough sleep, and managing stress levels. Avoiding excessive heat and sweating, which can exacerbate melasma, may also be beneficial.

When to See a Dermatologist

If you suspect you have melasma, it's important to consult with a dermatologist for an accurate diagnosis and personalised treatment plan. Here are some signs that it's time to make an appointment:

• The dark patches on your skin are persistent or getting worse over time
• Your symptoms are becoming more pronounced or uncomfortable
• You notice new symptoms or other changes in your skin's appearance
• You need professional guidance on the most effective melasma treatment options for your specific case

A dermatologist can assess your skin, determine the severity of your melasma, and recommend the best course of action. They may prescribe topical medications like hydroquinone, tretinoin, or corticosteroids, or suggest in-office procedures such as chemical peels, microdermabrasion, or laser therapy.

Your dermatologist can also provide guidance on melasma treatment at home, including product recommendations and sun protection strategies. They can monitor your progress and adjust your treatment plan as needed to help you achieve the best possible results.

Outlook and Living with Melasma

Living with melasma can be challenging, but there are several strategies you can use to manage the condition and improve your quality of life. In addition to following your dermatologist's treatment plan and practicing sun protection, it's important to take care of your emotional well-being.

Melasma can impact self-esteem and body image, so don't hesitate to seek support from loved ones or a mental health professional if you're struggling. Connecting with others who have melasma through online support groups can also provide a sense of community and helpful coping strategies.

Making lifestyle changes to reduce triggers and support skin health is also important. This may include adjusting your skincare routine, managing stress through relaxation techniques, and avoiding excessive heat and sweating.

Conclusion

While melasma can be a chronic condition, effective management is possible with the right combination of professional treatments, home remedies, and lifestyle changes. With patience and consistency, you can minimise the appearance of melasma and feel more confident in your skin.

At Metropolis Healthcare, we understand the impact that skin conditions like melasma can have on your quality of life. Our team of expert phlebotomists and lab technicians are dedicated to providing accurate, reliable diagnostic services to help you and your dermatologist make informed decisions about your treatment plan.