25 May Treating skin pigmentation – Melasma
Melasma is a common pigmentary disorder that leads to irregular brown patches on the face. The cheeks, central face and jaw may be affected. The brown discolouration is caused by an increased amount of melanin pigment in the skin.
Women who have melasma are usually very distressed due to the mottled brown appearance of their facial lesions, which may lead to feelings of embarrassment.
Who is affected by melasma?
Melasma is most commonly seen in young to middle-aged women (90%), but may also occur in men. It is more common in African, Hispanic and Middle Eastern women.
Pregnancy may also induce melasma and this is known as chloasma or the mask of pregnancy. Chloasma may disappear after the pregnancy but may unfortunately persist thereafter in some women.
Melasma may flare up due to sun exposure or due to medication use. Women usually complain that their melasma flares up in summer and improves in the winter months. It is believed that UV-radiation from the sun may be a causing factor. Hormonal factors may also play a role as we see that oral contraceptives may worsen the appearance of melasma.
The first step to managing melasma is to practise safe sun exposure. Sun avoidance (if possible) and sun protection in the form of a wide-brimmed hat and sun protective clothing should become part of your daily routine. Daily broad-spectrum sunscreen use is a must!
Avoid tanning beds. Tanning bed use may worsen the appearance of melasma and even worse, may increase your risk of developing skin cancer.
Apply make-up that minimises the appearance of pigmentation by concealing dark spots and providing an even tone effect.
If possible, discontinue oral contraceptive usage as it may exacerbate melasma.
Always consult a dermatologist regarding treatment options for melasma, so that the best treatment approach may be initiated. Treatment options include topical therapies such as hydroquinone and tretinoin (vitamin A). A potential side-effect with this therapy is skin peeling and redness. The treatment is used in a cyclical manner and is usually initiated in the winter months with breaks in summer, to avoid potential risk of hyperpigmentation from UV-radiation.
Laser therapy, light therapy and chemical peels are also other treatment options which can be discussed with your dermatologist.
Be wary of purchasing skin-lightening treatment as it may worsen melasma or even cause permanent skin discolouration. Melasma may require prolonged treatment and it can take months till the pigmentation improves. Patience and diligent adherence to treatment are key.
- Bolognia, Jean L., et al. Dermatology. Elsevier Health Sciences, 4th edition, 2018.
- Rivas S, Pandya AG. Treatment of Melasma with Topical Agents, Peels and Lasers: An Evidence-Based Review. Am J Clin Dermatol (2013) 14:359–376.