Melasma (Chloasma) Cure, Causes and Symptoms

Definition

Melasma is also called as cholasma or the mask of pregnancy. It is a dark skin discoloration found on sun-exposed areas of the face. It is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip. It presents as symmetric hyperpigmented macules, which can be confluent or punctate. The cheeks, the upper lip, the chin, and the forehead are the most common locations, but it can occasionally occur in other sun-exposed locations. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy medications. Melasma during pregnancy is relatively common. The dark patches typically last until the pregnancy ends.

Causes

1. The precise cause of melasma is unknown.
2. Heredity: People with a family history of melasma are more likely to develop melasma themselves.
3. Sex: Melasma is much more common in women than in men. Women are affected in 90% of cases. When men are affected, the clinical and histologic picture is identical.
4. A change in hormonal status may trigger melasma. Hormone replacement therapy used after menopause has not been shown to cause the condition.
5. Birth control pills may also cause melasma.
6. Young women with brownish skin tones are at greatest risk.
7. Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates.

Symptoms

1. A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical. It means it is similar on both sides of face etc.
2. Melasma are Irregular in shape. It appears as irregular or dark patches.
3. These patches often develop gradually over time.
4. Melasma doesn't cause any other symptoms besides skin discoloration but may be of great cosmetic concern.

Treatment

1. Melasma can be difficult to treat. The pigment of melasma develops gradually, and resolution is also gradual. Resistant cases or recurrences occur often and are certain if strict avoidance of sunlight is not rigidly heeded. All wavelengths of sunlight, including the visible spectrum, are capable of inducing melasma.
2. The mainstay of treatment remains topical depigmenting agents. Hydroquinone is most commonly used.
3. The use of tretinoin can be effective as monotherapy. However, the response to treatment is less than with Hydroquinone and can be slow, with improvement taking 6 months or longer.
4. Azelaic acid, available cream-based formulation appears to be as effective but very less as compared to Hydroquinone and superior it in the treatment of melasma. The mechanism of action is not fully understood. So it can be used in treatment of melasma.
5. In severe cases, laser treatments can be used to remove the dark pigment.
6. Strict sun avoidance is essential for resolution and to prevent recurrence.