What is melasma?
Melasma is a common frustrating disorder of hyperpigmentation affecting millions of people worldwide. It typically appears as irregularly shaped, but often distinctly defined, blotches of light- to dark-brown pigmentation. These patches are usually seen on the nose, cheeks, upper lip, forehead, chin and sometimes, the neck of women 20-50 years of age. Over 90% of all cases are women. Most people with melasma have a history of daily or intermittent sun exposure. People with olive or darker skin, like Hispanic, Asian, and Middle Eastern individuals, have higher incidences of melasma.
How to diagnose melasma?
It is usually readily diagnosed by its typical appearance on the face. Specialists often diagnose melasma by visually examining the skin. A black light or Wood’s light can assist in diagnosing melasma. Rarely, a skin biopsy may be necessary to help exclude other causes of this local skin hyperpigmentation.
What causes melasma?
The exact cause of melasma remains unknown. We believe that the dark patches in melasma could be triggered by several factors, including pregnancy, birth control pills, hormone replacement therapy, family history of melasma, race, antiseizure medications, and other medications that make the skin more prone to pigmentation after exposure to ultraviolet (UV) light. Uncontrolled sunlight exposure is considered the leading cause of melasma, especially in individuals with a genetic predisposition to this condition.
Where is melasma’s distribution on body?
Three types of common facial patterns have been identified in melasma, including center of the face, cheekbones, and jawbone.
Although it is commonly seen in areas that receive sun exposure; melasma has been reported on nipples and around the external genitalia.
What are the types of melasma?
Four types of pigmentation patterns are diagnosed in melasma: epidermal, dermal, mixed, and an unnamed type found in dark-complexioned individuals. The epidermal type is identified by the presence of excess melanin in the superficial layers of skin. Dermal melasma is distinguished by the presence of melanophages (cells that ingest melanin) throughout the dermis. The mixed type includes both the epidermal and dermal type. In the fourth type, excess melanocytes are present in the skin of dark-skinned individuals. In most cases, mixed melasma is diagnosed.
What is the treatment for melasma?
Epidermal melasma is easier to treat than dermal melasma because the melanin is at more superficial level in the skin and therefore can be more easily reached by topically applied products.
Several methods of treatment are available to patients with melasma. First-line therapy usually consists of topical compounds that affect the pigment production pathway, broad-spectrum photoprotection, and camouflage. Second-line therapy often consists of the addition of chemical peels, laser and light therapies represent potentially promising options for patients who are refractory to other modalities. A thorough understanding of the risks and benefits of various therapeutic options is crucial in selecting the best treatment.
All wavelengths of sunlight, including the visible spectrum, are capable of inducing melasma.
Do lasers work for melasma?
Yes, lasers are commonly used in melasma as destructive modality. It should be used with caution. In some experienced hands, they have been anecdotally reported to be safe and effective and to produce results much quicker than topical medications. Multiple laser treatments may be necessary to see results, as treatments are most effective when they are repeated. To ensure that treatment doesn’t fail, people must minimize sun exposure.
Can melasma be prevented?
Sometimes melasma may be preventable by avoiding facial sun exposure. In most cases, prevention is difficult. Individuals who have a family history of melasma must take extra precautions to prevent melasma. The most important way to prevent the onset of melasma and premature aging is to avoid the sun. If exposure to sunlight cannot be avoided, then hats, sunglasses, and sunblock with physical blockers should be worn.
What is the prognosis for melasma?
Melasma can be difficult to treat. Although melasma tends to be a chronic disorder with periodic ups and downs, the prognosis for most cases is good. The pigment of melasma develops gradually, and resolution is also gradual.
The gradual disappearance of dark spots is based on establishing the right treatment combination for each individual skin type. Resistant cases or recurrences of melasma occur often and are certain if strict avoidance of sunlight is not rigidly heeded.
Before and after treatment
Clinical Assistant Professor Dr. (Miss) Tan Kian Lee
Diploma in Aesthetic Medicine, MB,BCh.BAO, MMed(Surgery)