Melasma is a common benign condition characterized by one or more pigmented patches on the skin. It is more prevalent among women and less common in men. People with darker skin tones or those who tan easily have a higher likelihood of developing melasma. The condition occurs in all ethnic groups but is more frequent in individuals from Asia, the Middle East, and Latin America. The highest prevalence is seen in women between the ages of 20 and 40.
The pigmented patches are typically dark brown incolor and may occur in various numbers. In cases of multiple patches, theyoften merge and have a symmetrical distribution. The patches commonly appear inthe central forehead, upper cheeks, around the mouth, and on the upper lip(known as the "mustache" area). The pigmentation usually becomes morepronounced during the summer months.
Diagnosis is made through a simple examination of theskin. In rare cases, a biopsy (tissue sample) may be necessary to rule outother similar conditions that may require treatment.
Melasma results from increased production of melanin (skin pigment) in the affected skin. The exact cause is unknown, and identifying the triggering factor(s) is often challenging. In some cases, the pigmentation changes occur rapidly during pregnancy or with the use of oral contraceptives. However, the risk of melasma due to oral contraceptives has decreased with newer formulations containing lower hormone levels. There are also a few medications, such as phenytoin (used for epilepsy), that may cause melasma. The role of genetics in melasma is still being debated.
Melasma is a chronic and often recurrent condition, making it difficult to treat. Unfortunately, many individuals experience limited or no response to treatment and/or frequent relapses. However, for many people, the pigmentation improves over time, which can take several months to years, even after removing potential triggering factors (such as discontinuing oral contraceptives).
Treatment options for melasma depend on the individual's skin type. Available treatments include bleaching creams containing ingredients like vitamin A, hydroquinone, and steroids. Chemical peels or laser therapy may also be effective, but they are not the first-line options. It's important to note that both chemical peels and laser therapy can potentially worsen the condition and should be used with caution. Laser therapy is generally recommended for individuals with light skin types.
The most important preventive measure for melasma is sun protection. Facial sun protection is particularly crucial. Wearing a wide-brimmed hat and using a sunscreen with a high sun protection factor (SPF 50) that also protects against UVA rays are recommended. Depending on the location, year-round use of sunscreen may be necessary. Limiting sun exposure, especially during peak hours of intensity, is also advisable
There are several similar conditions characterized by increased pigmentation or brown discoloration of the skin. Examples of benign conditions include moles, solar lentigines (increased number of pigment cells in the skin), and post-inflammatory hyperpigmentation. Malignant conditions include lentigo maligna, lentigo maligna melanoma, and malignant melanoma.
