Dr. Kevin McKerrow
DERMATOLOGIST+ SEE BIO
Melasma appears as patchy shades of brown pigmentation on sun-exposed areas of the face. Melasma is more common in females and in darker skin types, and less common in fair or very dark skin.
It may occur in any population, but it is more common in those of East Asian, Indian, Pakistani, Middle Eastern and Mediterranean-African, Hispanic-American and Brazillian origin.
Proper treatment of the underlying medical condition is paramount, but excess hair removal can generally be provided concurrently with medical treatments. In addition, excessive hair growth can be genetic in nature. Though excessive hair growth due to genetic condition is not medically concerning, it may pose a major cosmetic concern.
Genetics: Some people are predisposed to this condition.
Hormones: Oestrogen from the pill or pregnancy stimulates the pigment producing cells in the skin, resulting in excess pigmentation. Some people, despite having no history of pregnancy or being on the pill have melanocytes which are just sensitive to normal amounts of hormones.
UV Light Exposure: Even brief exposure to UV light can stimulate pigmentation.The regular use of sunscreen is a cornerstone of treating melasma.
Patients usually give a history of the gradual onset of areas of dark facial skin. The pigmentation usually occurs on the face and is usually bilateral. The colour may vary from tan to brown, but it may be black or even have a blueish tinge. The distribution is usually symmetrical and three patterns are commonly seen – centrofacial, malar or mandibular.
The excess of melanin may be located in the superficial layers of the skin (epidermal melasma), the deeper layers of the skin (dermal melasma) but, more commonly, it is found in both layers of the skin (mixed melasma). The areas of skin most commonly affected are the forehead, cheeks and upper lip.
Melasma is usually diagnosed after examining the colour and pattern of the pigment. A Woods light (a special light used to assess the skin) may be used to determine the location of the pigment in those with lighter skin.
Melasma is challenging to treat, but it can be treated with a combination of various regimes – lasers, chemical peels and topical and systemic medications.
Epidermal melasma has a much better prognosis than mixed or dermal melasma, but all types are recurrent and require ongoing maintenance therapy. Melasma associated with pregnancy has the best chance of improvement, with pigment gradually fading over months. However, melasma often recurs in subsequent pregnancies.
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