Raechele Cochran Gathers, MD Melasma causes brown and discolored patches on the faces of many women. Melasma is a common condition that causes brown patches on the face. Usually, women get melasma. It occurs infrequently in men. Melasma doesn’t hurt or itch. It is a discoloration of the skin that typically has no symptoms.
The most common areas for developing these brown patches are:
- Upper cheeks
- forehead
- temples
- above the upper lip
- jawline
Who Gets Melasma?
Typically women between the ages of 20-50 develop melasma. Melasma has a hormonal component, and hormonal changes and fluctuations can cause it to occur. Women in this group may begin to notice the tell-tale brown patches on the face that can indicate melasma.
Women on birth control pills and hormone replacement therapy often develop melasma.
Other causes of melasma can include:
- Genetics
- Sun exposure
- Heat exposure
- Pregnancy
Melasma is so common in pregnant women that the condition has been referred to as “the mask of pregnancy.” Melasma occurs more frequently in those with darker complexions. It is more common in Asians, Hispanics and Middle Eastern women. Women of African ancestry also can develop melasma.
Causes of Melasma
Sun exposure is a key factor in the development of melasma. While the exact cause of how melasma develops is not completely clear, it appears to be triggered in large part by sun exposure. The interplay of sun, hormones (such as in pregnancy, birth control pills or hormonal contraceptives, and hormonal replacement therapy) racial background and genetics all play a role in determining who will develop melasma.
Some medications, such as some seizure medications, may make you more likely to develop melasma. Also, many medications (for instance, many blood pressure medications) can make you more sensitive to the sun. This could worsen your melasma! Melasma is often worse during summer months. In fact, some women need to proactively treat their melasma every summer.
Treatments for Melasma
Sunscreen is important in both the treatment and prevention of melasma. Without proper sun protection, the brown patches on the face of melasma can develop and worsen. When looking for a sunscreen, you should look for a broad spectrum sunscreen. Broad spectrum means that the sunscreen blocks both UVA and UVB light. Don’t use a sunscreen that is less than SPF 30. The other important thing is to apply your sunscreen every 2 hours to make sure that it is most effective.
Two recommended sunscreens are: Aveeno Positively Radiant Moisturizer with SPF 30 and Neutrogena Pure Screen. Neutrogena Pure Screen is a physical sunblock—good for those that are sensitive to chemical sunscreens or who wish to avoid chemical sunscreens. Hats are also important if you’re going to be in the sun. You need to protect your face from excessive sunlight.
Other Treatments
In addition to sunscreens, hydroquinones, either prescription strength or over-the-counter like Ambi Fade Cream, are helpful. Popular prescriptions for melasma might include tretinoin (found in the popular skin prescription Retin-A); Tri-luma (which is a combination of hydroquinone, tretinoin and a topical steroid); or azelaic acid, kojic acid and tranexamic acid, which can have lightening properties in darker areas.
Your dermatologist might also recommend chemical peels, microneedling, or even laser therapy such as the Fraxel laser for your melasma. If you have darker skin, it is very important to find a dermatologist that is skilled in performing these procedures on skin of color! Skin of color can react very differently than white skin to cosmetic procedures.
Outlook
If your melasma is worsened by your contraceptive or hormone replacement therapy, it may be necessary for your doctor to make some adjustments to your medication regimen. But many times, melasma can be treated with combination of sunscreen, sun avoidance, limiting heat exposure and the dermatologist-guided use of bleaching, exfoliating and skin rejuvenating treatments.
Featured Image: Courtesy of Samuel Freire da Silva, M.D. (www.atlasdermatologico.com.br)|Post Image: Int J Womens Dermatol. 2017 Dec 8;4(1):38-42.
