Melasma

Melasma is a common skin disorder. Loosely translated, the word means “black spot.” If you have melasma you’re probably experiencing light brown, dark brown and/or blue-gray patches on your skin. They can appear as flat patches or freckle-like spots.

Etiologic factors include genetic influences, ultraviolet (UV) radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. Genetic predisposition may be a major factor in the development of melasma. Melasma is more common in females than in males.

The most commonly used treatments for melasma are skin lightening medications that are applied topically. These include medications such as hydroquinone, azelaic acid, kojic acid, niacinamide, cysteamine, rucinol, and tranexamic acid.

If you have the dermal pigment, it may take longer to fade away than if you have the epidermal pigment. Melasma is typically a chronic disorder. This means that it’s long-lasting (three months or more). Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment.

Melasma is a very common skin disorder, especially among pregnant women. 15% to 50% of pregnant women get it. Between 1.5% and 33% of the population may get melasma and it happens more often during a woman’s reproductive years, and rarely happens during puberty. It usually starts between 20 and 40 years of age.

Fairer-skinned people are less likely to be affected by melasma than those with darker brown skin or those who tan well. Women are more likely to get melasma than men: about 10% of those who get melasma are men, 90% women. Pregnant women get melasma more often than anyone else. You’re also at risk if you take oral contraceptives and hormones.

There are three types of melasma and they have to do with the depth of the pigment. A Wood’s lamp that emits black light may be used to determine the depth of the pigment. The three types are:
1. Epidermal: Epidermal melasma has a dark brown color, a well-defined border, appears obvious under black light and sometimes responds well to treatment.
2. Dermal: Dermal melasma has a light brown or bluish color, a blurry border, appears no differently under black light and doesn’t respond well to treatment.
3. Mixed melasma: Mixed melasma, which is the most common of the three, has both bluish and brown patches, shows a mixed pattern under black light and shows some response to treatment.

Melasma is not cancerous, a sign of cancer, or a skin condition that “turns into” cancer. However, there are skin cancers that may mimic melasma, so seeing your dermatologist is often recommended to confirm the correct diagnosis.

There are two main causes of melasma: radiation, whether ultraviolet, visible light, or infrared (heat) light; and hormones.
Ultraviolet and infrared radiation from the sun are key in making melasma worse. Other possible causes of melasma include:
– Antiseizure medications: Drugs that prevent you from having seizures may be a cause of melasma. An example of an antiseizure medication is Clobazam (Onfi®).
– Contraceptive therapy (birth control): Melasma has been observed in individuals who use oral contraceptive pills that contain estrogen and progesterone.
– Estrogen/Diethylstilbestrol: Diethylstilbestrol is a synthetic (man-made) form of the hormone estrogen. It’s often used in treatments for prostate cancer. Again, there’s a pattern between increased estrogen and melasma.
– Genetics: About 33% to 50% of people with melasma have reported that someone else in the family has it. The majority of identical twins both have melasma.
Hypothyroidism: A condition where your thyroid is underactive.
– LED Screens: Melasma may be caused by the LED lights from your television, laptop, cell phone and tablet.
– Pregnancy: It is unclear why “the mask of pregnancy” happens to pregnant women. However, experts theorize that the increased levels of estrogen, progesterone and the melanocyte-stimulating hormones during the third trimester of pregnancy play a role.
– Hormones: Hormones like estrogen and progesterone may play a role in some people. Postmenopausal women are sometimes given progesterone, and have been observed developing melasma. If you aren’t pregnant, you likely have elevated levels of estrogen receptors found in your melasma lesions.
– Makeup (cosmetics): Some cosmetics can cause what’s called a phototoxic reaction.
– Phototoxic drugs (medicines that make you sensitive to sunlight): These include some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycaemics, antipsychotics, targeted therapies and some other drugs.
– Skin care products: A product that irritates your skin in general will likely make your melasma worse.
– Soaps: Some scented soaps are thought to cause or worse melasma.
– Tanning beds: The UV light produced by tanning beds damages your skin just as bad as the UV light from the sun, and sometimes worse.