What is melasma?

Melasma is a skin condition characterized by brown or blue-gray patches or freckle-like spots. These light brown, dark brown and/or blue-gray patches can appear as flat patches on face and other body parts. It is a common hyperpigmentation disorder found predominantly in women.

Where do melasma spots of pigmentation appear?

It is a hyperpigmentation disorder of face and other parts of the body. However, facial skin is mainly affected. Melasma may appear on your face, particularly on cheeks, upper lip forehead and forearms symmetrically.

Do seasons have any effect on melasma?

 Seasonal variation can have some effect on melasma and they often get worse in the summer and better in the winter. Probably it is due to the exposure to intense UV rays of sun in summer.

What are the causes of melasma?

·       Radiation from ultraviolet or infrared (heat) light of sun and over exposure to sunlight.

·       Pregnancy related increase in hormones

·       medications- for epilepsy or convulsions, some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycaemics, antipsychotics

·       birth control pills

·       hormonal therapy

·       LED lights from your television, laptop, cell phone and tablet.

·       Genes

·       Underactive thyroid [ hypothyroid state]

·       Some cosmetics or skin care products

Who are more predisposed to get melasma?

It is a very common skin disorder of pregnant women due to increasing female sex hormones in third trimester of pregnancy.

It can also occur in people on oral contraceptives and hormones.

Stress and sun exposure also may trigger it.

How to diagnose melasma?

A dermatologist can often diagnose melasma by close examination of your face. Using a Wood’s lamp, the hyperpigmentation can be accentuated when the pigment is epidermal.

Is vitamin D good for melasma pigmentation?

Yes. Vitamin D rich food may help to improve the general health of skin.

 Will melasma pigmentation go after childbirth?

Pregnancy related melasma pigmentation may fad a few months after childbirth and lactation period.

How can you manage or prevent melasma?

Genes or having family history of melasma is a little complicated to manage. It will not fade considerably by common skincare routine. However, there are some other causes of melasma which are preventable if you take some caution against harmful factors such as UV rays of sun, LED lights of TV, mobile phones, computers etc.

 Reduce your screen time. Use sun screen when you go out or get exposed to sun indoor also.

Avoid hormone-based birth control measures. Barrier methods of contraception may help to avoid hormonal pills.

What is the difference between pigmentation &melasma?

 Pigmentation refers to the discoloration of the skin, and it is caused by the production and distribution of pigments, which give color to different tissues, i.e. melanin produced by melanocytes in the skin.

  Melanin is responsible for the colour of the skin, hair, and eyes and helps protect the skin from the damaging effects of the sun’s ultraviolet (UV) radiation.

Melasma is a common skin condition and a type of hyperpigmentation that results in brown or greyish-brown patches. It typically occurs on the face, particularly on the forehead, cheeks, nose, and upper lip.

 However, it can also occur on other body parts frequently exposed to the sun, such as the neck and forearms.

What are the treatment options for melasma?

Treatment for skin pigmentation disorders depends on the underlying cause and the severity of the condition. Treatment may include topical treatments, such as skin-lightening agents, to procedures, such as chemical peels, microdermabrasion, or laser therapy. Sunscreens and other sun protection measures to prevent further damage to the skin are recommended.

It is suggested by healthcare providers that wearing protective clothing and sunscreen along with topical medications such as hydroquinone, tretinoin, or corticosteroids may help to remove melasma.  Sometimes, procedures such as chemical peels, microdermabrasion, or laser therapy may be necessary.

Melasma may go away on its own in some cases of pregnancy related dark spots. However, melasma can also last for years, or even a lifetime particularly in people having family history of melasma.

The most effective treatment combines sun protection with medications that you apply to your skin — and sometimes a procedure.

For people having melasma, dermatologists often recommend using a sunscreen that contains Zinc oxide, Titanium dioxide and Iron oxide.

Some medications include Hydroquinone, corticosteroids and topical applications.

Other medications:

your dermatologist may prescribe some other medications on your skin like azelaic acid, kojic acid, or vitamin.

Your dermatologist may suggest these procedures to your treatment plan:

·       Chemical peel: During this procedure, your dermatologist applies a chemical solution to the melasma. This can help remove excess pigment.

·       Microneedling: This minimally invasive procedure creates microscopic tears in your skin. As the skin heals, it tends to have a more even skin tone.

·       Laser and light treatments: a laser or light treatment can improve results for patients who are already applying medication to their skin and protecting their skin from the sun.

·       Platelet-rich plasma: This procedure involves taking a small amount of your blood, placing the blood into a machine that separates the blood into layers, and then injecting the layer of blood known as plasma into the skin with melasma. This can help even your skin tone.

Only a board-certified dermatologist should perform the above procedures.

Complementary &alternative medicine

Homeopathy for melasma hyperpigmentation

·       Arsenic alb

·       Coniummac

·       Lycopodium clavatum

·       Plumbum

·       Sepia

These medications are to be prescribed by qualified or medical council certified homeopathic doctors. In appropriate doses these may help to fade melasma spots.

References

1.        Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Mihm MC., Jr Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol. 1981;4(6):698–710. doi: 10.1016/S0190-9622(81)70071-9.

           https://pubmed.ncbi.nlm.nih.gov/6787100/

2.        Guinot C, Cheffai S, Latreille J, Dhaoui MA, Youssef S, Jaber K, et al. Aggravating factors for melasma: a prospective study in 197 Tunisian patients. J Eur Acad Dermatol Venereol. 2010;24(9):1060–1069. https://pubmed.ncbi.nlm.nih.gov/20202051/

3.        Ritter CG, Fiss DV, Borges da Costa JA, de Carvalho RR, Bauermann G, Cestari TF. Extra-facial melasma: clinical, histopathological, and immunohistochemical case–control study. J Eur Acad Dermatol Venereol. 2013;27(9):1088–1094. doi: 10.1111/j.1468-3083.2012.04655.x.

4.        https://www.aad.org/public/diseases/a-z/melasma-treatment

5.        Image courtesy-https://www.freepik.com/free-photo/side-view-smiley-man-skin-texture_27621779.htm#page=2&query=hyperpigmentation&position=4&from_view=keyword&track=sph&uuid=8fe566bf-f9e0-416c-bc54-1cb51f56b74c