Facts You Never Knew About Melasma

A skin disorder called melasma is characterized by brown, blue-gray, or freckle-like areas on the skin. Melasma develops when the cells that determine your skin’s color are overproduced; it is often referred to as the “mask of pregnancy.” It is common, safe, and certain treatments could be beneficial. Usually, melasma disappears after a few months.

What exactly is melasma and how does it appear?

Melasma is a typical skin condition. If you have melasma, you likely have light brown, dark brown, and/or blue-gray areas on your skin, which loosely translates to “black spot.” They may look as flat patches or dots that resemble freckles. Your face, particularly the cheekbones, upper lip, and forehead, as well as your forearms, are often affected regions. Because it often affects pregnant women, melasma is sometimes referred to as the “mask of pregnancy”. Melasma often becomes worse in the summer and better in the winter as it gradually darkens and lightens.

Chloasma is a different, less popular term for melasma. Even though this disease is entirely safe, some individuals may experience self-consciousness as a result.

Where does melasma often manifest?

Melasma often develops on your cheekbones, nose, chin, forehead, upper lip, and surrounding skin. Sometimes, it has an impact on your back, neck, and arms. Melasma may really damage any area of your skin that is exposed to the sun. Because of this, the majority of melasma sufferers observe that their symptoms are worse in the summer.

How widespread is melasma?

Skin conditions like melasma are highly prevalent, particularly among pregnant women. It affects 15% to 50% of expectant mothers. Melasma may affect 1.5% to 33% of people, and it often appears during a woman’s reproductive years and seldom during adolescence. Typically, it begins between the ages of 20 and 40.

Who is susceptible to melasma?

People with fairer complexion are less prone to get melasma than individuals with deeper brown skin or who tan easily. Melasma affects 10% of males and 90% of women, making women more prone to get it than men. Melasma affects pregnant women more often than anybody else. If you use oral contraceptives or hormones, you’re also at danger.

What transpires behind the skin?

Three layers make up your skin. The epidermis is the top layer, followed by the dermis in the middle, and the subcutis at the bottom. The biggest organ in your body, it is an organ that accounts for around one-seventh of your total body weight. Your barrier is made of your skin. Your bones, muscles, organs, and everything else are shielded from the elements, bacteria, sunlight, dampness, toxins, injuries, and more. Additionally, it aids in maintaining a healthy body temperature, guards against dehydration, and allows you to detect sensations like the warmth of a stove, the texture of your dog’s tummy, and the pressure of another person holding your hand.

Melanocytes, which are found in your epidermis, store and create the dark pigment known as melanin. Your skin darkens because the melanocytes create more melanin in response to hormone stimulation, light, heat, UV radiation, or hormonal stimuli.

Why do women get melasma during pregnancy?

The hormones progesterone and estrogen are present in higher amounts in pregnant women. These hormones may be a factor in your melasma. After pregnancy, the deeper color normally disappears.

What kinds of melasma are there?

Melasma comes in three different varieties based on the intensity of the pigment. To ascertain the depth of the pigment, utilize a Wood’s lamp that generates black light. They are as follows:

• Epidermal: Epidermal melasma is characterized by a dark brown hue, a well defined boundary, and the ability to be seen under a black light. It may sometimes react favorably to therapy.
• Dermal: Dermal melasma has a hazy border, a light brown or blue tint, and does not change under a black light. It also does not react well to therapy.
• Mixed melasma: The most prevalent of the three, mixed melasma has both blue and brown patches, has a mixed pattern under black light, and exhibits some therapeutic response.

Is Melasma Cancerous?

Melasma is not a cancer, does not indicate malignancy, and does not progress to cancer. To confirm the accurate diagnosis, however, it is often advised to see your dermatologist since several skin malignancies may resemble melasma.

Is Melasma Permanent?

Melasma is a chronic condition most often. This indicates that it lasts a long time—at least three months. Melasma may affect a person for months, years, or their whole life. Melasma may only be present in certain individuals temporarily, such as during pregnancy.

Is Melasma Painful?

Melisma is not harmful. Nothing about it hurts, itches, or is unpleasant.

SIGNIFICANCE AND CAUSES

What brings on melasma?

Melasma has two basic causes: hormones and radiation, including ultraviolet, visible, and infrared (heat) light.

The sun’s ultraviolet and infrared rays have a major role in aggravating melasma. Other potential melasma causes include:

• Anti-seizure drugs: Medicines that stop seizures might be a factor in the development of melasma. Clobazam (Onfi®), an anti-seizure drug, is an example.
• Melasma has been seen in those who use oral contraceptives that include progesterone and estrogen (contraceptive medication, birth control).
• Diethylstilbestrol, a synthetic (man-made) version of the hormone estrogen, is also known as estrogen. It is often used in the treatment of prostate cancer. Once again, there is a correlation between elevated estrogen levels and melasma.
• Genetics: Between 33% and 50% of those who have melasma say that a family member also has the condition. Melasma is common in identical twin pairs.
• Your thyroid may be underactive if you have hypothyroidism.
• LED screens: The LED lights from your tablet, phone, laptop, and television may contribute to melasma.
• Pregnancy: The cause of “the mask of pregnancy” in pregnant women is unknown. The elevated amounts of estrogen, progesterone, and melanocyte-stimulating hormones during the third trimester of pregnancy may nonetheless play a part, according to specialists’ theories.

• Hormones: In certain persons, hormones like progesterone and estrogen may be involved. It has been noted that postmenopausal women who get progesterone sometimes develop melasma. Your melasma lesions most likely include higher than average amounts of estrogen receptors even if you aren’t pregnant.
• Cosmetics: A condition known as a phototoxic response may be brought on by certain cosmetics.
• There are many antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycemics, antipsychotics, targeted treatments, and other medications that are phototoxic (make you sensitive to sunshine).
• Skin care products: Melasma is likely to become worse if you use a product that generally irritates your skin.
• Soaps: It’s believed that certain perfumed soaps might worsen or bring on melasma.

• Tanning beds: The UV radiation generated by tanning beds may sometimes be even more damaging to your skin than the UV light from the sun.

What melasma symptoms are there?

Your skin may develop blue, light brown, dark brown, or freckle-like areas due to melasma. The areas may sometimes swell up or become red. Melasma develops on your skin in six different places, or a combination of places:

• Brachial: Your shoulders and upper arms show signs of melasma.
• Centrofacial: Your forehead, cheeks, nose, and upper lip all exhibit melasma.
• Lateral cheek pattern: Both cheeks are affected by the melasma.
• Malar: Your cheekbones and nose are where the melasma is visible.
• Mandibular: The jawline displays the melasma.
• Neck: Melasma may develop on all sides of the neck in adults 50 years of age or older.

If you have melasma or another form of skin problem, your healthcare practitioner will determine for sure.

Does melasma react to certain foods?

Experts currently are not aware of any foods or beverages that either directly cause, miraculously cure, or exacerbate melasma. However, consider a diet rich in foods containing vitamin D to maintain your skin healthy in general:

• Coconut milk
• Eggs
• Meat
• Milk
• Mushrooms
• Fatty fish
• Citrus juice
• Yogurt

Does having melasma make me more likely to have thyroid disease?

Thyroid disorders are more prevalent in those with melasma. Your thyroid may be examined by a medical professional.

TESTS AND DIAGNOSIS

To identify melasma, a dermatologist or other healthcare professional will check your skin. They’ll observe variations in the hue of your skin using a Wood’s lamp (a black light). Given that melasma and thyroid problems do seem to be related, you may want to get your thyroid tested.

Sometimes, melasma is confused for a different skin disease. Your healthcare professional may conduct a biopsy, in which a tiny portion of your skin is taken and studied, to differentiate between various skin disorders. A standard operation carried out during a regular visit to your healthcare provider’s office is a rapid, safe biopsy. Skin disorders that are often mistaken for melasma include:

• Lichen planus and actinic lichen planus
• Coloration brought on by drugs
• Hypomelanosis guttate
• Ochronosis brought on by hydroquinone exogenously
• Lentigo (spots of aging)
• Hori’s Nevus
• Ota’s Nevus
• Coloration after inflammation

The findings of the biopsy often show the following if you have melasma:

• Dendritic (branched) melanocytes with pigment
• Basal and suprabasal keratinocytes contain melanin
• Melanin found in melanophages in the dermis
• Fragmentation of elastic fibers and solar elastosis

The Melasma Area and Severity Index (MASI) may be used to determine how severe your melasma is. The test could be carried out by your healthcare professional.

What inquiries could my doctor make to determine if I have melasma?

• When did you first notice the skin discoloration?
• Where on your body are the blemishes located?
• Does your family have a history of melasma?
• Are you expecting?
• Which soaps do you employ?
• What makeup/cosmetics do you employ?
• Do you suffer from any other skin conditions?
• Are you looking for medicines to treat your melasma?
• Are you considering treatments that might lessen your melasma?
• Is it possible to have melasma on the skin?

Typically, melasma is flat. If you are worried about another kind of skin disease, see your doctor.

Melasma develops gradually over a few weeks or months.

Freckles: Are these melasma?

Although they are not the same skin disease, freckles and melasma spots may sometimes be confused.

Are liver spots, age spots, and sun spots melasma?

They could seem similar! On the other hand, melasma patches are often bigger than age spots, sun spots, or liver spots. If you have concerns about a different issue, talk to your doctor.

CONTROL AND TREATMENT

Melasma is challenging to manage. Your healthcare physician must first identify the potential causes of the melasma in order to develop a treatment strategy. Is it daytime? Your contraception? Genetics? Is that soap? Using screens too much?

Melasma may fade away on its own, be permanent, or react to therapy within a few months depending on the individual. The majority of melasma instances will go away over time, particularly if you shield yourself well from sunshine and other sources of light.

Unfortunately, melasma cannot be permanently removed with a single therapy. Dermal pigment cannot yet be eliminated.

Avoid these things if you have melasma:

• Hormone therapies, particularly those that use estrogen
• Birth control, especially estrogen- and progesterone-containing oral contraceptives
• LED light from your tablet, phone, laptop, and television
• Makeup that makes your skin uncomfortable
• Drugs that might aggravate or cause melasma
• Fragranced soaps
• Goods for skin care that make your skin itch
• Tannery tables
• Waxing, which could make the melasma worse

I have melasma; do I need to visit a dermatologist?

Yes. A dermatologist may provide therapies that your regular doctor might not be able to.

Can melasma disappear by itself?

Yes, it’s conceivable that after a few months, your melasma may disappear on its own. While you are pregnant or on hormone contraceptives, it is unlikely to go away. To prevent your melasma from worsening or, if it does diminish, from returning, take precautionary measures like avoiding sunlight. Melasma may reappear.

Exactly how is melasma handled? What drugs are helpful?

Making sure that your melasma doesn’t become worse is the first step in treating it. Avoiding the sun, tanning beds, LED screens, unpleasant soaps, and birth control that contains hormones can help you achieve this. Wear a wide-brimmed hat and sunscreen with iron oxides and an SPF of 30–50 every two hours if you will be exposed to the sun. By doing these actions, your melasma may stay the same or improve.

Topical medicines are the second option. By halting the production of melanin (the dark pigment), topical treatment with tyrosinase inhibitors limits the creation of new pigment. Tyrosinase inhibitors and other sorts of beneficial substances include:

Azelaic acid is used twice daily as a cream, lotion, or gel. It is safe to use when pregnant.

Cysteamine: A short trial involving 50 participants discovered that cysteamine cream was superior to a placebo.

Topical corticosteroid hydrocortisone: Hydrocortisone aids in the fading of melasma’s color. Additionally, it may reduce the possibility of dermatitis brought on by other substances.

The drug hydroquinone is used as a cream or lotion. For two to four months, it is applied directly to the melasma patches at night.

Methimazole: This antithyroid medication is available as a pill or cream. It is reported to be effective in treating hydroquinone-resistant melasma.

Soybean extract: It’s believed that soybean extract lessens the amount of color that melanocytes transmit to skin cells.

Alpha hydroxy acid topical: pigments on the epidermis may be scraped off. Skin surface is removed with this cream or chemical peel.

Tranexamic acid is a drug that may be taken orally, as a cream, or via injection.

Topical retinoid on prescription, tretinoin. It is efficient but should not be taken when pregnant since it may lead to dermatitis.

Melasma has responded well to a combination of hydroquinone, tretinoin, and a mild topical steroid.

Other substances being researched to treat melasma include:

• Vitamin C is ascorbic acid.
• Arbutin.
• Deoxyarbutin.
• Glutathione.
• Kojic acid, also known as kojic acid dipalmite.
• Liquorice essence.
• Mequinol.
• Resveratrol.
• Runicol.
• Sulfated zinc.

Do the drugs have any adverse effects or complications?

Hydroquinone and tretinoin have the adverse effect of causing dermatitis. Azelaic gel, cream, or lotion may cause pain. Be alert for any allergic reactions at all times. Please inform your healthcare professional of any adverse effects. To prevent the negative effects, it could be advisable for you to switch to a different medicine.

Lasers and chemical peels have the potential to kill skin cells in the epidermis, produce post-procedure hyperpigmentation, and create hypertrophic scars. Only medical professionals with expertise treating melasma should use them in conjunction with topical medicines to ensure safety.

How long will it take the drugs to start working?

It is dependent upon the individual and the drug used. Melasma may take some time to improve after therapy. Rarely do the aforementioned treatments completely eliminate all melasma.

Are there any treatments for melanomas?

You don’t have to use topical medication. Your dermatologist can do certain treatments to treat your melasma.

Your dermatologist will apply a chemical to your skin during a chemical peel, which might cause it to peel. Smoother and more uniformly pigmented skin should result from the regeneration process.

light-based techniques using low fluence Q-switched lasers, non-ablative fractionated lasers, and strong pulsed light.

What should I do if I have melasma and am pregnant?

When you are no longer pregnant, your melasma should go. If it doesn’t, discuss your healthcare provider’s available treatment alternatives. Use only topical and oral medications that are safe for pregnant women while you are using them.

What expert should I consult for melasma treatment?

A dermatologist is an expert in skin issues. Your melasma may be managed and treated with their assistance.

Can melasma be concealed by makeup?

Yes, but be sure to use sunscreen-infused cosmetics and watch out for any that can make your melasma worse by causing skin irritation.

What vitamins are there that I may use to treat melasma?

In general, vitamin D keeps your skin healthy. To ensure that you are consuming adequate vitamin D from foods rich in vitamin D, such as meat, cereals, fatty fish, and eggs, your healthcare practitioner may test your vitamin D levels. Another option is to use a vitamin D supplement. Set the daily threshold at 2,000 International Units (IU).

If I stop using birth control, will my melasma disappear?

Yes, if the hormones in your contraceptives are what are causing your melasma. The melasma often takes three or more months to go away.

Will my melasma go after I have a baby? What happens if I stop nursing?

The melasma should go away three months after you stop being pregnant.

PREVENTION

Can melanomas be avoided?

Unfortunately, you cannot halt the skin issue while pregnant or prevent heredity. However, you may be able to avoid the things mentioned above that aggravate melasma. Melasma cannot currently be totally prevented by treatment. However, a skin-friendly diet with enough vitamin D is probably going to be helpful.

PERSPECTIVE / PROGNOSIS

What can I anticipate if I’ve been given a melasma diagnosis?

A harmless skin ailment is melasma. It doesn’t itch, it doesn’t pain, and it doesn’t get cancerous. If you don’t take action, such as avoiding the sun and soaps and cosmetics that irritate your skin, expect it to become worse and/or recur.

How long will my melasma last?

It could take longer to disappear if you have dermal pigment than if you have epidermal pigment. Melasma is often a chronic condition. This indicates that it lasts a long time—at least three months. Melasma may be temporary, persistent, or responsive to therapy depending on the individual. Your melasma could go away if you practice preventive measures and adhere to any treatments advised by your doctor.

LIFE WITH MELASMA

How can I look after myself?

Avoid going outside in the sun without sunscreen. Reduce the amount of time you spend in front of your tablet, smartphone, computer, and LED television. Pick a birth control technique that doesn’t use hormones. Use the management and treatment recommendations given to you by your dermatologist or other healthcare professional. Additionally, check the diagnosis with your healthcare practitioner to ensure that you are receiving the appropriate care.

How does it feel to have melasma?

Physically, melasma is not harmful, but it may be emotionally upsetting. Some individuals may feel uncomfortable letting others see their skin issues. Thankfully, melasma usually disappears after three months.

When should I schedule a melasma consultation with my doctor?

When you notice melasma symptoms, schedule an appointment with your doctor as soon as possible to begin treatment. Treatments will be more difficult to provide as the condition worsens.

What inquiries should I make of my doctor about melasma?

• Do I suffer from melasma or another skin condition?
• What supplements or drugs may I use to treat my melasma?
• How many hours of sunshine should I get each day?
• Do you have a particular sunscreen that you suggest?
• Are the soaps I’m using right now making my melasma worse (please provide a list)?
• How should I use birth control?
• Are any of my current drugs making my melasma worse or contributing to it?

Overview

Although melasma is frequent, typical, and safe, it may be inconvenient. If this skin condition makes you feel self-conscious, it may have an impact on your social life. There are therapeutic choices, so you don’t have to “live with it.” There are steps you can do to avoid problems. Dermatologists are available that can assist you. Express your worries and ask them questions.

Always pay attention to your doctor’s recommendations and strictly adhere to your treatment plan.