Melasma, also known as Cholasma, is a common condition more often found in women than in men. Although it has been known to affect women of all skin tones, those with darker tones (Indians, Hispanics, Middle-Easterners, and North Africans) are more susceptible to this condition while 10% of the cases involve dark skinned men. Melasma is characterized by irregular tan or brown patches of dark skin on the face or more specifically on the cheeks, upper lip, nose, forehead, jawline and in rare occasions the forearms. Melasma is often mistaken for a common suntan but it is the symmetry of Melasma which distinguishes it from other conditions that also cause darkening of the skin. Within a patch of Melasma, pigment producing cells (called melanocytes) are increased in number and each melanocyte produces more pigment (called melanin). It is the increased melanin in the skin that leads to the tan or brown coloration. The cause of Melasma is not fully understood, however genetics, hormonal changes, and sun exposure are known to play important roles. Also, Melasma often occurs with pregnancy (although a woman doesn't have to be pregnant to be affected) as it is sometimes referred to during this period as "mask of pregnancy". In addition, oral contraceptives can trigger Melasma and although there are some diseases that cause similar changes in the skin, Melasma itself has no association with any internal disease.
Above all, sun exposure is the main cause of contracting Melasma as the skin tends to darken in summer after sun exposure and then fade in winter when the sun is less exposed. This happens because the skin's pigment, melanin, absorbs the energy of the sun's UV rays in order to protect the skin from overexposure. Tanning occurs as a result causing dark areas to become even darker. Because of this, Melasma occurs more frequently in light brown or bronze skin types from regions of the world with intense sun exposure. Also, as with many beauty concerns like cellulite and acne, genetics plays a major role which is why more than 30% of sufferers have a family history of it while skin inflammations from allergic reactions, or waxing of facial hair, especially above the lip, can also be a trigger. Some medications such as the antibiotics tetracycline and minocycline in addition to some anti-seizure and anti-malarial drugs can also cause Melasma.
Although there are no cures for this condition, there are a number of treatments available for Melasma which will minimize the problem and keep it under control. These include: topical bleaching creams, sunscreens, chemical peels, and laser therapy. Hydroquinone 4% is widely considered the most effective skin lightening agent. Even with these over the counter options, it is imperative that you don't self-treat as only a dermatologist is qualified to remedy this condition. Also, pregnancy induced Melasma may resolve itself spontaneously soon after delivery. Some prescription bleaching formulas are marketed to consumers via the Internet, but these can cause severe reactions on certain skin types and should only be used under medical supervision. Lightening agents like kojic acid, derived from fungal or mushroom plants, are often combined with other ingredients like azelaic acid, glycolic acids, lactic acid, retinol, ascorbic acid, and botanical lighteners such as licorice extract and bearberry extract. Most skin lightening ingredients work better in tandem than on their own. For example, glycolic acid helps draw lightening agents into the skin better. It is important to understand that skin lightening is not a quick process. Depending upon how dark the area is compared with your normal skin tone, it can take six months to one year to see results and non-prescription lightening creams can go only so far in improving the appearance of Melasma. If you are seeking more dramatic improvement, you may have to look to more invasive remedies performed mostly by plastic surgeons. Superficial glycolic peels, trichloracetic acid peels (TCA), microdermabrasion, and intense pulsed light treatments are the most common methods used to even out skin pigment although these treatments tend to be more risky for darker skin types. Some prescription bleaching formulas are marketed to consumers via the Internet, but these should only be used under medical supervision and can cause severe reactions on certain skin types. Lightening agents like kojic acid, derived from fungal or mushroom plants, are often combined with other ingredients and azelaic acid, glycolic acids, lactic acid, retinol, ascorbic acid, and botanical lighteners such as licorice extract and bearberry extract. Most skin lightening ingredients work better in tandem than on their own. For example, glycolic acid helps draw lightening agents into the skin better.
The most important method in avoiding brown patches is to wear sunscreen with a minimum SPF15 all day, every day, year-round. Even incidental exposure such as through your car window on an overcast day can exacerbate Melasma. The most effective sunscreens, including zinc oxide and titanium dioxide, should be applied every two hours and not just once in the morning. Consider SPF in your moisturizer and foundation as just icing on the cake as it is not enough to protect you all day long. Of course minimizing sun exposure in general can prevent darkening of existing dark patches as well as the appearance of new areas. This is especially important for women who take birth control pills or hormone supplements or for past Melasma sufferers. Once you have successfully lightened up your dark areas, maintenance is needed to keep the skin clear for the long term.
As a rule, any persistent and unexplained darkening or lightening of the skin should be looked at by a Dermatologist. The first step by him or her is to determine the cause by conducting a complete medical history and a proper physical examination including evaluating the skin under a Wood's lamp. Diagnostic tests, including thyroid function tests and skin biopsies may also be done. The next step is to eliminate the cause, if possible. For example, if the cause is due to any medications you are taking, discontinuing these may result in a clearing. But Melasma is not always that simple because the pigment may be located in the epidermis or the skin's outer layer, the dermis or the deeper layer, or a combination of both. The more superficial it is, the easier it will be to lighten. In general, the sooner that the Melasma is detected the better it will respond to treatment. Rule number one is that nothing will be effective if you are still trying to tan because that will completely reverse the healing process and re-pigmentation will begin again.
This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician