Melasma

Melasma is a skin condition characterized by discoloration on the cheeks, forehead, nose, or upper lip. It often occurs on sun-exposed areas and can affect anyone, but is most often seen in young women with brownish skin tones. It is more common in certain ethnic groups, especially Latinos.

Causes

The cause of melasma is unknown, but pregnancy, hormonal treatment and birth control pills can trigger and/or worsen melasma.

Melasma that occurs in pregnant women is often referred to as “pregnancy mask.”

Because sun exposure can increase the risk of melasma, it is most common in tropical climates.

Symptoms

Melasma is not associated with any symptoms other than skin discoloration. The coloring often matches on each side of the face, and is commonly seen over the cheeks, forehead, nose, and upper lip. It may appear as a uniform brown color, or it may resemble sun damage or freckles.

Treatment

Treatment for melasma can be challenging since there are some resistant cases.

The most important step in the treatment of melasma is sun protection.

Sun protection is important every day, not only when going to the beach or the pool. We are exposed to the sun daily when walking on the street from home, to the bus stop or car, from home to the supermarket, etc.

The sun has two types of ultraviolet rays that reach the earth: ultraviolet A and ultraviolet B. Ultraviolet B is the sunlight that causes sunburns. Ultraviolet B penetrates deeper into the skin and is more responsible for wrinkles and dark spots.

Window glass, windshields or clouds do not filter the UV-A rays, which are more responsible for dark spots. Therefore, sun protection is necessary throughout the year, not only during summertime, but even when it is cloudy.

Try to avoid sun exposure between 10 a.m. and 4 p.m. Wearing a hat can block some of the sun’s rays, but because hats create only SPF 8 coverage, they may not be enough on their own.
The daily use of an appropriate sun block of at least SPF 30 is extremely important in preventing skin conditions such as melasma. Reapply sunblock every 2 hours if you are outdoors.

The best sun block for melasma is a broad spectrum sun block, which block both UV-A and UV-B rays. We recommend physical sun blocks composed of particles that refract the UV light, such as micronized zinc oxide or titanium dioxide.

No sun block is 100% effective, therefore sun avoidance is also important.

Topical creams can help improve the appearance of melasma. One of the most effective creams is a combination of Hydroquinone, Tretinoine and a corticosteroid. Botanical substances such as Kojic acid and Licorish can also help.

In some cases, chemical peels, microdermabrasion or laser treatments may be used. If the coloring is related to hormonal changes, it often fades after discontinuing the use of birth control pills or hormone replacement therapy, or after giving birth. It may return if you become pregnant again or resume use of these medications.

Avoiding the sun and using sunscreen is important in keeping melasma from developing or worsening.

Melasma has a tendency to return, therefore it is very important to continue sun avoidance and the use of sunscreens even if the melasma has gone away.