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Melasma

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Melasma

Melasma is a common skin disorder in women. It is an acquired, chronic and recurrent hyper pigmentary disorder. The condition is often referred to as a mask of pregnancy, referring to the high prevalence of the disease in pregnant women. Melasma is characterized by light brown to bluish-grey patches with irregular, sharp borders. The skin condition usually affects the photo-exposed areas, especially the face and neck. The face, cheeks, forehead, nose, upper lip, or temples are involved. Melasma can affect self-image and self-esteem and negatively impact a patient’s quality of life. The depigmentation provided by most of the current treatment is temporary, and recurrences are frequent. However, there are various beneficial topical treatments.

Symptoms of Melasma

Melasma causes patches of discolouration usually appear on the cheeks, forehead, bridge of the nose and chin. It usually affects facial skin. It can also develop on the neck and forearms. The skin condition may often appear exposed to the sun and develop melasma. The skin discolouration does not cause any physical harm but may make you self-conscious about its appearance. 

Causes and risk factors associated with melasma

It is still not understood what causes melasma. Darker-skinned individuals are at high risk compared to people with fair skin complexion. Estrogen and progesterone reactions are also associated with the condition. This means the usage of contraceptive pills, pregnancy, and hormone therapy can all trigger melasma. Thyroid disease and stress can also contribute to melasma. In addition, sun exposure can cause melasma because sun rays affect the skin cells that control pigment (melanocytes).

Diagnosis of melasma

A visual clinical examination is often enough to diagnose melasma. To rule out specific causes, your dermatologist might also perform some tests.  

One testing method is a Wood’s lamp examination. A special kind of light is used to help your skin during the procedure. It allows your dermatologist to check for infections caused by bacteria and fungi and determine how deep the melasma affects the skin. Furthermore, for any serious complication, they might also perform a biopsy. A small piece of the affected skin is taken for testing to perform a biopsy.

Treatment

For some women, melasma resolves on its own. When the hyperpigmentation disorder is caused by pregnancy or birth control pills, it usually disappears on its own. There are topical formulations your dermatologist can recommend that can lighten the skin. They might also prescribe topical steroids to reduce the dark patches on the skin.

If the topical therapy doesn’t work for you, other treatments like chemical peels, dermabrasion, and microdermabrasion are possible options. These treatments remove the top affected layer of the skin and help reduce the appearance of dark patches on the skin.

These methods do not guarantee that hyperpigmentation won’t re-appear, and some cases of melasma can’t be completely lightened. You might have to visit your dermatologist for follow up treatments and adhere to certain treatment practices to reduce the recurrence of dark patches. Most common practices include minimizing sun exposure and wearing sunscreen regularly.  

Common treatments for melasma:

  • Hydroquinone:

Dermatologists often prescribe hydroquinone for the treatment of melasma. Hydroquinone formulations are considered the first-line treatment for this hyperpigmentation disorder. An individual can apply the preparation directly to the dark patches of the discoloured skin. Hydroquinone products work by lightening the dark patches. 

  • Corticosteroids and tretinoin:

Corticosteroids and tretinoin are available in creams, gels, or lotions. Both the active ingredients lighten the colour of melasma patches.  

  • Combination of topical formulations:

In some cases, dermatologists may prescribe combination therapies containing hydroquinone, tretinoin and corticosteroid. These are often called triple combination therapies.  

  • Medical procedures

If topical therapies do not work, a dermatologist may ask you to undergo certain procedures. These include:

  • Chemical peel
  • Microdermabrasion
  • Dermabrasion
  • Light therapy
  • Laser treatment

Some of these procedures have side effects or may cause additional skin issues. It is always best to talk to a dermatologist about possible risks. If a person is dealing with melasma, it is important to avoid triggers by limiting sun exposure, using sunscreen, and wearing a hat when outside.

Management

Not all cases of melasma resolve with treatment; there are tips you can follow to make sure the condition doesn’t get worse and to minimize the appearance of dark patches. These include:

  • Use makeup to cover areas the dark areas of your skin
  • Using prescribed medicine on time
  • Wearing sunscreen every day with SPF 30
  • Wearing protective clothing (full sleeves tops, a wide-brimmed hat) that provides shade for your face.

Following these measures is especially important if you will be in the sun for an extended period. 

Outlook

Treatment works for some people. Melasma caused due to hormonal fluctuations may also fade over time once the hormone levels reach to normal state. If you are concerned about the dark patches on your skin, speak to your dermatologist. Also, meeting other people with the same condition or talking with somebody close to you can give you hope and motivation to deal with your skin condition.

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