Melasma is a condition where one develops dark brown and gray patches most notably on the forehead, upper lip, nose and cheeks. It can also occur on the forearms and neck.
I consider melasma to be a very rapid, uneven suntan.
Why should I care about melasma?
Melasma is a condition that occurs in both men and women. Ninety percent of melasma cases occur in women; however, 10 percent of cases will occur in men. This is a common condition that can occur after pregnancy or after the use of birth-control pills, prescribed hormones, or, rarely, other medications.
What causes melasma?
Melasma is caused by a combination of genetics, hormones and sun exposure. The cells in the skin that produce color are called melanocytes. For some unknown reason, melanocytes residing in the forehead, cheeks, upper lip, and sometimes
forearms can become sensitized by hormones (pregnancy and birth control pills) or certain medications. When this occurs, exposure of these areas to the sun causes a rapid production of the substance that darkens the skin called melanin. Melanin acts like an umbrella to protect the skin from additional sun exposure/damage. “Chloasma” is the old term for the dark patches that occur after pregnancy, and some call it “the mask of pregnancy.” The term melasma is now most commonly used.
How is melasma diagnosed?
Melasma is easily diagnosed with pregnancy, medication history, timing of appearance, and location. There is a very rare birthmark that can look like melasma, and in cases where melasma is completely resistant to treatment, a biopsy may be needed to explore other diagnoses.
Can melasma be prevented?
Knowing one’s family history, predisposition for the condition, and, as always, implementing good sun protection is essential. I recommend a sunscreen that is broad-spectrum with a UV and SPF rating of 30. Sunscreens must be applied 30 minutes before going out in the sun, and then reapplied every hour and more frequently if either perspiring or swimming.
How is melasma treated?
Melasma is notoriously difficult to treat. I use topical medicines either independently or a combination of them including hydroquinone, retinols, Kojic acid, and vitamin C. In addition to these measures, alpha-hydroxy acid chemical peels, deep melanage peels, and the use of the Pixel laser can also be helpful.
Sometimes, based on a patient’s genetics, the cells that produce color, (melanocytes), reside deep in the skin. The medicines and lasers that are used can only penetrate so far and may not reach deeply enough for good treatment results.
In fact, in about a quarter of all cases, even with our very best efforts, we cannot successfully treat melasma to the patient’s satisfaction. Also, it is important to note that even if we are successful in treating melasma, without meticulous sun protection it can return.
Action steps for anyone with melasma
Realize that this condition is best viewed as a chronic medical condition that needs a lifetime of attention, or it will return or get worse. Talk to your pharmacist about over-the-counter options. If these don’t work, see a board-certified dermatologist for other stronger topical treatments and/or combination laser treatments with peels. Most importantly, if melasma is successfully treated, appropriate sunscreen must be used meticulously for a lifetime to prevent its recurrence.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.