Melasma

What Is Melasma?

Melasma is defined as an acquired hypermelanosis of sun exposed areas. Melasma is commonly seen on the cheeks, the chin, the forehead and the upper lip. But in very rare cases it can be seen on other sun-exposed locations

Melasma normally appears as symmetric hyperpigmented macules, which can be either confluent or punctate. If Melasma occurs during pregnancy, then it is termed as Chloasma. Generally, the word chloasma is derived from a Greek word chloazein and it means, “to be green”. The word

Melas of Melasma is also a greek word and it means “Black”. But as we known that the pigmentation is never green in appearance, hence the term Melasma is much preferred.

Causes of Melasma

Melasma is thought to be having direct relationship with female hormonal activity because it is seen commonly in pregnant woman and the women who make use of oral contraceptive pills.

There are various photosensitizing medications, which lead to melosma. Milk ovarian or thyroid dysfunction may also lead to development of Melasma. There are certain cosmetics, which causes Melasma.

The most important factor in the development of melasma is exposure to sunlight. Even the treatment for melasma, fails if the person strictly does not avoid sunlight. All races are equally affected by melasma.

But it is more commonly seen in the darker skin types than in lighter skin types. Moreover, melasma is much more common in women than in men. Melasma occurrence is very rare before puberty and it most commonly occurs in women during their reproductive years.

Genetic factor plays a major role in the development of melasma. Person with light brown skin types who have suffered from intense sun exposure are much more prone to the development of melasma.

Usually, no laboratory tests are advised. Wood light examination helps to localize the pigment to the epidermize or the dermis. But in many cases, the pigment is found in both locations. Epidermal melanin is found in keratinocytes in the basal and suprabasal area.

Treatment for Melasma

Melasma is generally difficult to treat. As the pigment of melasma develops slowly and hence its resolution is also gradual. Moreover, all wavelengths of sunlight are capable of causing melasma, hence resistant cases or recurrences occur often and are very common if strict avoidance of sunlight is not done.

Treatments like Cryotherapy, medium depth chemical peels, etc. shows vary good results but there are certain adverse effects like epidermal necrosis, post inflammatory hyper pigmentation and hypertrophic scars.

In order to provide early relief from melasma, many doctors perform milk exfoliation with superficial chemical peels. Moreover, if melanogenis is prevented with the use of bleaching agents then the time of resolution can be reduced.

Hence we can say that treating melasma with superficial chemical peels and a bleaching agent is safe and effective. The major treatment of melasma is the use of topical depigmenting agents. Hydroquinone is most commonly used.

It leads to the decreased production of melanin. Hydroquinone can be applied in cream form or as an alcohol-based solution. But there can be certain side effects like skin irritation, phototoxic reactions with secondary post inflammatory hyper pigmentation, etc.

Azelaic acid can be used in cream based formulation for the treatment of melasma. Person should also take measures to avoid sun exposure like the use of hats should be made and the sunscreen should be applied over the exposed body parts.

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