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Melasma

MELASMA

What is Melasma?

Melasma is a skin condition characterized by patches of pigmentation on the face.  It is an hypermelanosis of areas of the skin which are exposed to the sun.

What causes Melasma?

The exact causes of melasma are not known. Ultraviolet (UV) light stimulates melanocytes to produce more pigment. The actual number of melanocytes are not increased, they just become hyperactive.

There are some factors which may contribute to melisma-pregnancy, hormonal drug changes, the oral contraceptive pill, and hormonal disorders such as hypothyroidism.  Melasma surfaces more during the summer months and can improve during winter. Excessive sun exposure and resulting sun damage is known to aggravate melisma.  Enlarged and abnormal blood vessels have been found on biopsies of patients with melasma which are also seen in sun damage.

Who is at risk of Melasma?

Melasma can affect both genders and all races.it however, is more common in women and people with darker skin tone and mostly occurs between the age of 20 and 40 years. Asian, Hispanic, Middle Eastern and Mediterranean are more to be affected. Melasma is less common in black skin.

What are the symptoms of Melasma?

Melasma is hyperpigmentation of some areas on the skin. It is marked by light brown or dark brown patches with some greyish tone to them. It is mostly witnessed on the cheeks, forehead, upper lip,nose, chin and jaw. The pigmentation often has a reticulate or lace like pattern to it. Though it is a benign condition, it tends to cause distress among the patients as it hampers their appearnce.

How is it diagnosed?

There is a peculiar pattern to melisma, the dermatologist while taking in account the medical history of the patient’s family can distinguish the hypopigmentation from other causes. In rare occasions a biopsy may also be required. A tool named Wood’s light is used for examining a patient with rosacea to examine the depth of the pigment. This in turn helps to design the treatment. The deeper pigment ,the more resistant it is to topical treatment.

How does a Dermatologist treat Melasma?
  • If the melasma appears to be associated with intake of the oral contraceptive pill ,then changing the particular medication may also help.
  • Melasma associated with pregnancy usually resolves postpartum.
  • Several topical medications may be advised along with usage of sunscreen.
  • Laser therapy can also be considered to treat melasma. Currently used laser modalities for melasma include low fluence Nd-YAG laser treatment which is known as ‘laser toning’ and non-ablative fractionated resurfacing.
  • Chemical peels are used for the treatment of melasma . the results may vary and may not be permanent. Tranexamic acid, which is an anti fibrinolytic agent, taken
  • If the melasma is not responding to any of the treatments, then camouflage make-up is chosen to conceal the pigmented patches.