Melasma

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Melasma, also known as “Chloasma faciei” (or in pregnant women as the mask of pregnancy), is a tan or dark skin discoloration. Melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications. It is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian and Jewish descent (on the face).

Melasma has been considered to arise from pregnancy, oral contraceptives, endocrine dysfunction, genetic factors, medications, nutritional deficiency, and liver dysfunction. Melasma is reasonably common, especially in women of child-bearing age. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this melasma. Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. While all races are affected, there is a prominence among Latinos and Asians.

Melasma is a common skin condition. It is a non-cancerous (benign) disorder of unknown cause that causes dark (hyperpigmented) patches, primarily on the face. Most melasma occurs in women. Only 10% of those affected are men. The condition is marked by brown patches that worsen in response to increases of the hormone estrogen, such as during pregnancy or with the use of birth control pills.

The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Melasma is usually diagnosed visually or with assistance of a Wood’s lamp (340 - 400 nm wavelength). Under Wood’s lamp, excess melanin in the epidermis can be distinguished from that of the dermis.

Melasma is more apparent during and after periods of sun exposure and less obvious in winter months, when sun exposure is lacking. It most commonly occurs on the cheeks, forehead, upper lip, nose, and chin. It is best to begin treatment at the first sign of melasma in order to have the best chance of preventing and treating it. Sunscreen is the most important factor for successful treatment.

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