Melasma is a common skin disorder which causes the discoloration on the skin. People suffering with this problem is having dark or light brown pigmentation or patches on their skin, primarily on their face. It may appear as flat patches or freckle like spots. Most commonly affected areas are 

  • Cheeks
  • Forehead
  • Upper lips 
  • Bridge of the nose
When melasma occurs during pregnancy, it is called chloasma, or "the mask of pregnancy. Melasma may also appear to those area of the body which are more exposed in sun like
  • Forearm
  • Neck
  • Shoulder
According to the survey, melasma is much more common in women & only 10% men are affected with this problem. Melasma is mostly occur more in those people who tan easily or having natural brown skin & comparatively less common in fair & dark skin people. Its an onset between the age of 20 to 40 years. This is harmless & common problem, no pain, no itching, nothing uncomfortable & some treatment may help to fade those skin discoloration.

Reasons For Melasma

Doctors wont able to figure it out the exact reason of melasma but it may be due to malfunctioning of the melanocytes(melanin producing cells) in the skin which causing them to produce too much colour. Melasma may darkens or lightens with the passage of time, usually getting worse in summer & better in winter. 

Potential reasons for triggering melasma
  • Family history of melasma
  • Hormones disorder during pregnancy
  • Birth control pills
  • Hormone replacement therapy(HRT & Progestrone) 
  • Excessive exposure of sun
  • Those with melasma are more likely to have a thyroid disease. 
  • Melasma may cause by the LED lights from television, laptop, cell phones & tablets.
  • During pregnancy estrogen, progesterone & melanocyte-stimulating hormones increases due to which this problem may occur.
  • Postmenopausal women are sometimes given progesterone which develops melasma
Types of Melasma

There are 3 types of melasma which defines the depth of the pigmentation. Wood lamp, dermoscopy, reflectance confocal microscopy (RCM) may help to identify the depth of pigmentation. 

  • Epidermal: Epidermal melasma has a dark brown color, a well-defined border, appears obvious under black light and sometimes responds well to treatment.
  • 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.
  • 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.
Is Melasma Permanent

Its a chronic skin disorder which means its a long lasting problem. It may have three month or one year or for the entire life. Pregnant lady may have melasma for just a short period of time i.e. during the pregnancy & after delivery it fades away gradually.

Sign of Melasma

Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. Sometimes the patches can become red or inflamed. Melasma appears in six locations or a combination of locations on your skin:

  • Brachial: The melasma appears on your shoulders and upper arms.
  • Centrofacial: The melasma appears on your forehead, cheeks, nose and upper lip.
  • Lateral cheek pattern: The melasma appears on both cheeks.
  • Malar: The melasma appears on your cheeks and nose.
  • Mandibular: The melasma appears on the jawline.
  • Neck: In people age 50 or older, melasma can appear on all sides of the neck.
Treatment

Melasma can be treated with the following combination of tropical creams i.e. hydroquinone, tretinoin, corticosteroid. Other topical agents are used too.  
  • Azelaic acid
  • Kojic acid
  • Cysteamine Cream
  • Ascorbic acid
  • Methimazole
  • Tranexamic acid
  • Glutathione
  • Soybean extract
Other Treatments

Chemical peels & laser is also using for the treatment of melasma. But these treatment should be used with care as it has a risk to make the melasma worsen or causing post inflammatory hyperpigmentation.

Epidermal pigmentation can be treated with chemical peel like alpha-hydroxy acids (AHA), such as glycolic acid or beta-hydro acid(BHA) such as salicyclic acid. Microdermabrasion to dermabrasion (light to deep) & Q-switched laser is also used to treat melasma but its on high risk to relapse & become more tough to treat. 

Melasma slowly respond to the treatment which is very bothersome for patient as well as for dermatologist. 

How to deal Melasma

Its not necessary that melasma will fade away completely after taking the treatments. It may relapse again so in that case to minimise the visibility of the discoloration in the following ways:

  • Use full coverage makeup to cover the discoloration
  • Use the prescribed medication
  • Apply sunscreen daily with SPF 40 at least three to four times a day.
  • Cover your face as much as possible with scarf or use umbrella. 
  • Bio oil is also a good option for melasma. It helps gradually to fade away the patches or discolouration.