Melasma: Causes, symptoms and options for treatment

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Oswald Lightsey Mikell

Melasma is very common and occurs in up to six million American women. It is a skin condition in which dark patches appear on the face (forehead, cheeks, and upper lip) and is caused by excessive pigment (melanin) collecting in the skin.

The dark patches usually have distinct edges and are symmetrical (similar on both sides of the face).

Although people with melasma may be concerned about its appearance, it's a harmless condition.

Q: Are there different type of melasma?

A: Yes, there is epidermal and dermal melasma. Epidermal melasma means the pigment (melanin) is in the more superficial layers of the skin called the epidermis.

Dermal melasma means that the pigment is in the deeper layers of the skin. This distinction is important because epidermal melasma responds more quickly to treatment.

Q: Who is at risk for melasma?

A: Although melasma can occur in men, it is most common in women, especially in women with darker or olive-colored skin. If your relatives had melasma, you are also at greater risk of developing melasma.

Women are also at greater risk of developing melasma if they are pregnant, take birth control pills, or take hormone replacement therapy. When melasma occurs during pregnancy, it is also called chloasma, or "the mask of pregnancy."

Studies have shown that postmenopausal women who receive progesterone hormone replacement therapy are more likely to develop melasma. Postmenopausal women receiving estrogen alone seem less likely to develop melasma.

Sunlight is essential to the development of melasma. Most people with melasma have a history of daily or intermittent sun exposure, although heat is also suspected to be an underlying factor. People at risk of developing melasma will notice the patches becoming darker following exposure to sunlight.

Q: What is the treatment?

A: Treatment results vary greatly. Your recommended treatment will depend largely on your type of melasma, dermal or epidermal. You should consult your doctor for the proper course of treatment.

The medications prescribed for melasma are called "bleaching" or "depigmenting" agents that cause the skin to stop making melanin. Your doctor might discuss the option of various dermatologic procedures that may reduce the appearance of the dark patches, including chemical peels, dermabrasion, or lasers.

While waiting for the discoloration to fade, consider using concealer to reduce the appearance of melasma.

Q: How long is the treatment period?

A: Some people with epidermal melasma experience rapid improvement within four to eight weeks of starting treatment, while others may find that improvement takes many months.

Q. Is there anything I can do to prevent melasma from returning?

A: Avoiding exposure to sunlight is the most important step in treating melasma and preventing its return. Sunlight is a powerful trigger of pigment formation in people susceptible to melasma. It is strong enough to counteract the effects of medications, even through car windows or on cloudy days.

It may take time to respond to treatment, so be patient. Call a dermatologist if you have any concerns.

Dr. Oswald Lightsey Mikell, certified by the American Board of Dermatology and the American Board of Cosmetic Surgery, is the owner of Dermatology Associates of the Lowcountry.

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