SKIN CONDITIONS
Melasma
A skin condition, more common in women, causing brown patches of pigmentation on the face.
- Usually triggered by sun exposure, light and hormonal changes
- Harmless but may cause emotional distress
- Treatments include topical fading agents and laser
Melasma, also known as chloasma, is a common long-term skin condition that causes facial pigmentation. It tends to worsen in response to light, both ultraviolet and visible wavelengths, and hormonal influences; it commonly appears during pregnancy.
Melasma is not known to cause serious physical health issues, but it can have a significant effect on emotional well-being and quality of life. The condition can persist for many years or may be permanent in some cases.
Who gets melasma?
Melasma tends to appear in young adulthood (20 to 40 years of age). It’s more common in people with darker skin types, and people with a family history of melasma.
Melasma affects women five to ten times more commonly than men. It is more common during pregnancy, affecting 25-50% of women, and in response to hormonal treatments such as oral contraceptives or hormone replacement therapy.
What causes melasma?
Melasma occurs when melanocytes, the pigment-producing cells in the skin, produce excessive pigment. Pigment may leak into lower levels of the skin, making it more difficult for many topical treatments to work effectively. In many cases, there appears to be excessive growth of skin blood vessels.
Triggers for worsening of symptoms include:
- Sun and other forms of light: Ultraviolet (invisible) and visible wavelengths of light (especially blue and violet colours).
- Relatively low levels of light – even indoors in some cases – can make melasma pigmentation worse.
- Hormones due to pregnancy, oral contraceptives and hormone replacement therapy.
- Skin inflammation and irritants, including scented cosmetics and soaps.
- Medications that make the skin more sensitive to sunlight can worsen melasma.
- Heat can make melasma worse by stimulating melanocytes and dilating blood vessels.
What does melasma look like?
Melasma appears as patchy brown discolouration on the skin, often appearing on the forehead, cheekbones and along the jawline. Patches are light to dark brown in colour, sometimes with grey or pink tones. The borders are irregular and may be well or poorly defined, depending on the depth of pigmentation. The distribution is usually symmetrical, i.e. the same on both sides of the face.
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Melasma, seen from right profile, affecting the forehead
Close-up view, melasma on the cheek and temple of a young man
Close-up view of melasma on a young woman's forehead
Close-up view of melasma pigmentation and increased vascularity on a woman's cheek
Treatment of melasma
Treatment of melasma requires a combination of measures, both medical and general.
Medications
Topical and oral medications can reduce melanin production and skin inflammation.
Q-switch laser treatment
Lasers can target and destroy pigment and small blood vessels. Q-switch is a form of laser that uses extremely short pulses of light to avoid heating the skin excessively.
Topical skin care products
Ongoing skin care using topical skin care products aims to reduce irritation and pigment production.
Complications of melasma
Melasma can have a significant psychological impact on some people. It can lead to feelings of shame, frustration, and low self-esteem, affecting quality of life and social interactions.
Controlling melasma
Controlling melasma requires long term and constant attention to skin care.
Use the highest possible SPF sunscreen every day, even in winter.
Avoid exposure to the sun by wearing a hat and sunglasses to shade your face. Stay in shaded areas when outside.
Avoid substances that may irritate the skin. These include fragrances, toners, alcohol-based products, essential oils and astringents.
Use moisturiser and anti-pigmentation products such as vitamin C daily.
Treatments for melasma
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