Melasma

Melasma is a frequently acquired skin condition that manifests as a blotchy, brownish pigmentation on both sides of the face. The name chloasma was once used to describe this type of face pigmentation, but because it comes from the Greek word melasma (brown skin), it is now preferred. The mask of pregnancy was also a nickname for it.

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Everything you should know about Melasma


When prevalent in pregnant women, melasma, also known as chloasma faciei or the mask of pregnancy, is tan or dark skin pigmentation. Sun exposure, genetic susceptibility, hormonal fluctuations, and skin irritation are considered to be the causes of melasma. Although it can affect anybody, it is more frequent in women, particularly pregnant women and those who use oral or patch contraception or hormone replacement therapy drugs. 

Melasma is caused by an overproduction of the cells that give your skin its color. It’s a common ailment that’s completely painless, and certain therapies may assist. After a few months, melasma normally disappears.

Melasma causes light brown, dark brown, and/or blue-gray areas on your skin. Flat patches or freckle-like markings are common. Face, especially the cheekbones, upper lip, and forehead, as well as the forearms, are commonly affected.

Melasma often darkens and lightens over time, with summers being worse and winters being better. It is also known as chloasma, which is a less frequent term. Even though this illness is innocuous, it can cause some people to feel self-conscious.

Before the creams and steroids start to fade, they must be used for at least eight to twelve months. As a result, the many treatments and medical visits come at a cost. Furthermore, melasma laser therapy is a costly procedure. Patients are likely to require 3-4 treatments over the course of 3-6 months. The sum might be anything between Rs 50,000 and Rs 100,000.

Melasma treatment is a lengthy procedure. The spots melt away with time, and the discoloration returns to normal. If the black or brown pigments are limited to a few spots, the therapy might take up to nine months to complete. However, if it spreads across a large area of the face, it will take considerably longer to remove and will require ongoing therapy.

If sufficient care and safeguards are exercised, the therapy typically has a long-term effect. Pigmentation removal does not ensure that it will not reappear in the future. If the skin is exposed to too much sunlight or if there is a hormonal imbalance, the patches may reappear. Sunscreen and protective masks must be used throughout long periods of time spent outside in the sun to avoid this.

Melasma therapies may cause transient skin irritation as a side effect. This might be due to the skin type of the individual. This, however, disappears when the skin responds to the medications. Exogenous ochronosis is a side effect that can occur when people consume hydroquinone in very high quantities for lengthy periods. While using a bleaching product, the skin darkens rather than lightens in this scenario.

Melasma’s actual etiology is yet unclear. Several variables, including pregnancy, birth control pills, hormone replacement therapy (HRT and progesterone), familial history of melasma, race, and anti-seizure drugs, are thought to induce the dark patches in melasma. Sunlight is thought to be the most essential component in the development of melasma, especially in people who have a hereditary susceptibility to it. Melasma is more common in the summer months, when the sun is most powerful, according to clinical research. Melasma pigmentation tends to fade in the winter.

Melasma is sometimes known as chloasma, or the mask of pregnancy when it appears during pregnancy. During the second and third trimesters of pregnancy, pregnant women’s estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels rise. Melanocytes are pigment-producing cells in the skin. Pregnancy-related melasma, on the other hand, is considered to be produced by higher levels of progesterone rather than estrogen and MSH.

Melasma is more likely to occur in postmenopausal women who use progesterone hormone replacement treatment, according to studies. Melasma appears to be less common in postmenopausal women who get just estrogen.

In addition, irritated skin can lead to an increase in melanin synthesis, which can hasten the onset of melasma symptoms.

Melasma is more likely to occur in those who have a genetic susceptibility or a family history of the disease. Sun avoidance and the use of additional sunscreen are important preventative measures for these people to avoid increasing pigment development. These people should talk to their doctor about their concerns and, if feasible, forgo birth control drugs and hormone replacement therapy (HRT).

Melasma is caused by a genetic predisposition, which is a crucial element in deciding whether or not someone will get it. People of African, Asian, or Hispanic ancestry who have the Fitzpatrick skin type III or above are at a substantially higher risk than others. Furthermore, women with a light brown skin tone who live in areas with a lot of sun exposure are more likely to acquire this illness.

Melasma is also more common in those who have thyroid problems. Stress-induced overproduction of melanocyte-stimulating hormone is suggested to be a factor in outbreaks of this illness. Melasma can also be caused by an adverse response to drugs or cosmetics

Melasma displays itself as dark, irregular, well-defined, hyperpigmented macules to patches. Usually, these patches appear gradually over time. Aside from the aesthetic discoloration, melasma has no additional symptoms. Patches can range in size from 0.5 cm to more than 10 cm in length, depending on the individual. It can be found in the Centro facial, malar, or mandibular regions.

Melasma might develop on other parts of your body that are frequently exposed to the sun.

Patches of brownish hue frequently develop on the:

  • Cheek
  • Forehead
  • Nose’s bridge
  • Chin

It’s also possible to get it on your neck and forearms. Although the skin darkening causes no physical harm, you may be self-conscious about how it appears.

Consult your doctor if you detect any of these melasma symptoms. They may send you to a dermatologist, a specialist who specializes in the treatment of skin conditions.

Unfortunately, you can’t avoid genetics or stop a skin disease from developing while you’re pregnant. However, you may be able to prevent the elements that aggravate melasma. There is no treatment that can entirely prevent melasma at this moment. A skin-friendly diet with proper vitamin D levels, on the other hand, is likely to assist.

It is essential to take efforts to lower your chance of acquiring melasma to safeguard your skin’s health. Here are some helpful hints for preventing melasma and maintaining good skin:

  • Reduce the amount of time you spend outside in the sun

Spending time outside is beneficial to your health, but try to avoid going outside between 11 a.m. and 3 p.m., when the sun is at its strongest. When you’re outside, attempt to wear lightweight clothing and wide-brimmed hats to reduce the amount of skin exposed to the sun.

  • Make use of sunscreen

To block UV rays, a daily sun protection factor (SPF) of at least 50 with physical blockers like zinc oxide and titanium dioxide is advised, but it’s also crucial to have a sunblock that also protects against UVA. Chemical blockers may not be as effective as zinc or titanium at blocking both forms of UV-A and UV-B. Melasma treatments are more successful when sun protection is used on a regular basis.

  • Wear safety gear and clothes

Go big or go home, is our suggestion. You can never have enough protection from the sun’s rays. Take out your largest sunglasses and a hat with the broadest brim. Another good technique to protect your skin is to wear UV protection clothes with SPF.

  • Advice for expecting mothers

Melasma, which can develop as a result of changes in hormone levels, may not be preventable in pregnant women. You may, however, limit your time in the sun during your pregnancy. Use the skincare products we suggest, such as sunscreens, cleansers, and moisturizers, to keep your skin moisturized and healthy.

Melasma is classified into three categories based on pigment depth. To assess the pigment depth, use a Wood's lamp that generates black light. The three kinds are as follows:

  • Epidermal

Epidermal melasma has a dark brown hue, a well-defined border is visible under black light, and responds favorably to therapy in certain cases.

  • Dermal

Dermal melasma has a light brown or blue tint, a hazy border, and does not react well to therapy.

  • Mixed melasma

The most frequent of the three, mixed melasma has both bluish and brown patches, a mixed pattern under black light, and a response to therapy.

Melasma can be treated with numerous different types of lasers.

  • IPL

Intense Pulsed Light (IPL) is a type of laser that employs multispectrum photons of various wavelengths to target certain colors in your skin. Because this therapy has the potential to exacerbate melasma in particular skin tones, it’s crucial to speak with a dermatologist before starting.

  • Q-Switch

The Q-Switch laser, also known as The Spectra, sends light into your skin that breaks down melanin into tiny bits, which your body subsequently removes. Q-Switch has the potential to bleach your hair, which might induce a stinging feeling.

  • Fractional

Fractional laser resurfacing, also known as Fraxel, creates minute holes in the skin that promote the creation of new, healthy skin cells. The operation causes a prickling sensation, and a topical anesthetic is frequently used before it. Immediately after, your skin appears red, discolored, and raw. Your skin will seem brighter and more even after 3 to 5 days of healing.

Here are some resurrected clinics’ innovative approaches to treating melasma.

  • PicoSure

PicoSure is a type of laser that converts energy into pressure rather than heat. It works swiftly to treat melasma at its root underneath the skin. The operation itself takes only a few minutes and is just somewhat painful. A stinging sensation comparable to a rubber band snapping on the skin is possible. PicoSure decreases melasma without causing additional negative effects including hyperpigmentation, according to one research.

  • Flutamide

 Flutamide is a nonsteroidal antiandrogen that binds to the androgen receptor, blocking the activity of both endogenous and exogenous testosterone. A total of 74 women were involved in a 16-week randomized experiment that compared flutamide 1% with hydroquinone 4% once daily. Flutamide and hydroquinone 4% both showed equivalent effectiveness in MASI and colorimetry scores, indicating that they improved skin hyperpigmentation.

  • Glutathione

GSH is a tripeptide made up of glutamate, cysteine, and glycine that is one of the most effective endogenous antioxidants generated by human cells. Inhibition of tyrosinase and the capacity to skew eumelanin to pheomelanin synthesis are two mechanisms that lead to skin whitening.

The following are some of the points that can assist dispel the melasma myths:

  • Melasma is a condition that arises as a result of pregnancy.
  • Pigmentation is a hereditary condition that cannot be avoided.
  • Melasma may be avoided by solely using sunscreen while going out in the sun.
  • The treatment’s effects last indefinitely.
  • Melasma can be treated with any laser.

Hyperpigmentation is simply a darkening of the skin produced by anything –

acne scars, freckles, extended UV and infrared exposure, eczema or psoriasis discoloration, and so on. Melasma, on the other hand, is mostly caused by estrogen, which is why it is more common in women. It’s most frequent during pregnancy, when using birth control tablets, or when taking hormone treatment. It is also more common in Indian women. Melasma is made worse by exposure to the sun and heat. 

The look is another significant distinction between hyperpigmentation and melasma. Melasma shows up as blotchy yet symmetrical patterns on the cheekbones, bridge of the nose, forehead, chin, and upper lip, whereas hyperpigmentation appears as random spots or patches anywhere on the face and neck.

External factors influence hyperpigmentation, whereas internal causes influence melasma.

While hyperpigmentation may be treated with a variety of over-the-counter medications containing brightening agents like vitamin C, kojic acid, niacinamide, hydroquinone, azelaic acid, and home remedies, Melasma is a challenging skin condition to cure. There is no such thing as a one-size-fits-all solution for melasma, and the same treatment may not work for two distinct persons with the condition. Melasma hasn’t had the same level of effectiveness or consistency with over-the-counter medications, however, you may still keep the issue under control by sticking to the fundamentals. 

Topical medications

Topical medications include:

  • Cysteamine

Cysteamine hydrochloride is a breakdown product of the amino acid L-cysteine that occurs naturally in the human body. Cysteamine also acts as a radioprotector, shielding cells from the mutagenic and other deadly effects of ionizing radiation by scavenging hydroxyl radicals directly.

  • Pigment-correcting serum 

To address the numerous processes involved in the production of hyperpigmentation, pigment-correcting serum was recently modified. Melanocyte activation, melanosome formation, melanin production, melanosome transfer, and keratinocyte differentiation and desquamation are some of the mechanisms that are involved. TA, tetrapeptides, plankton extracts, niacinamide, phenyl ethyl resorcinol, and undecylenate phenylalanine are among the ingredients in the pigment-correcting serum.

  • Methimazole 

When administered topically, methimazole, an oral anti-thyroid medicine used to treat hyperthyroidism, has been proven to produce depigmentation. Methimazole produces considerable skin lightening in people with melasma and post-inflammatory hyperpigmentation. Methimazole is a peroxidase inhibitor that prevents melanin production. Methimazole should only be used on melasma-affected regions and not as a general cosmetic lightening agent.

Oral medications

Oral medications include

  • Tranexamic acid 

Tranexamic acid (TA), a lysine derivative, is a fibrinolytic drug that inhibits plasminogen binding to keratinocytes by blocking the conversion of plasminogen to plasmin. Reduced arachidonic acid production, as well as prostaglandin and fibroblast growth factor synthesis, are some of the downstream consequences.

Melanin production is triggered by prostaglandins and fibroblast growth factors. Mast cells and angiogenesis are both reduced by TA. Melasma requires 250 mg twice a day oral dose, whereas bleeding diatheses require 3900 mg daily treatment. 

  • Melatonin

Melatonin is a powerful antioxidant and free-radical scavenger that activates many antioxidant enzymes, including superoxide dismutase, glutathione reductase, and glutathione peroxidase, which are all released by the pineal gland. Melatonin also blocks the receptors for the melanocyte-stimulating hormone.

In a study of 36 individuals with melasma and ten healthy controls, oral and topical melatonin was tested. The MASI score was significantly lower in all patients with melasma. Furthermore, malondialdehyde, an oxidative stress marker, dropped while glutathione (GSH) levels increased, indicating a considerable reduction in oxidative stress.

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