Pregnant women know this all too well, the dark brown or greyish mask which covers your cheek, forehead or chin that is melasma. Melasma is known as the mask of pregnancy and is triggered by the increase in hormones from pregnancy. Although, melasma does not only affect women 90% of the sufferers are women (especially in those with darker skin tones). When melasma develops in your teens or early twenties it may last for decades.
What is melasma?
Melasma is a type of hyperpigmentation caused by the overproduction of melanin which is triggered by hormonal changes from oral contraceptives, HRT and or pregnancy, which increases the skin’s sensitivity to ultraviolet light. Melasma is different from other types of hyperpigmentation because it is much more difficult to treat due to the challenges in preventing its triggers.
While melasma isn’t painful and doesn’t present any health risks, it can cause significant emotional distress, in addition to the fact it is difficult to treat there is a lot of misinformation on the causes.
Causes of Melasma
There are a good number of causes of melasma however 2 are the most prominent
Hormones/Hormonal fluctuations
Hormonal fluctuations cause melasma which is why it occurs more commonly in pregnancy and tend to affect women much more than it does men. Stopping or starting hormonal contraception’s (pills, injectable or HRT) can also trigger melasma.
Sun exposure
Exposure to UV rays is another huge trigger for melasma, so hormonal changes may not cause melasma until a person is exposed consistently to sunlight and boom there it is. In addition to the sun is a major exacerbating factor, it is also worsened by heat and visible light so if you live in the tropic like Nigeria treating Melasma becomes even more difficult. It also means that sunscreens alone cannot prevent melasma from forming especially in the very hot and bright months.
Genetics
Melasma has a genetic component and often runs in families.
Diagnosis
There a many causes of hyperpigmentation so the first step is confirming with a dermatologist that you actually have melasma and identifying the underlying cause. Melasma can be easily diagnosed by its appearance, it is usually symmetrical on both cheeks, bridge of the nose, forehead, chin, or upper lip. It has no physical symptoms so apart from the discolouration the affected skin is not itchy or painful.
Other methods of diagnosis include using a Wood’s lamp which utilizes ultraviolet light to identify the lesions on your skin and in rare cases take a small biopsy. Although it is less common in other parts of the body, melasma can appear on parts of the body exposed to sunlight.
Treating melasma
The first step in treating melasma is identifying and treating the trigger, without removing the trigger it will certainly reoccur. Although the treatments for melasma is the same as other types of hyperpigmentation, it is difficult to treat because it does not respond consistently to over the counter products. This is compounded by the fact the response to the treatment varies widely among different individuals, so what works for one person may not work for the other. Because of the emotional distress caused by persistent melasma, women may seek dangerous treatments online which can be dangerous. One of the treatments bought online is oral or injected glutathione which is not approved by any government agency and can cause thyroid or kidney problems.
Stay out of the sun
This is almost impossible but the next best thing is to wear sun protection consistently. Because the effects of the sun will negate any treatment you are given. So you need to use a physical sunscreen that protects you from the sun’s rays as well as light and heat. Physical sunscreens contain zinc and titanium dioxide, you can read about the types of sunscreens here and how they work. A physical sunscreen stops both UVA and UVB rays from penetrating your skin. Chemical sunscreens are not effective in preventing melasma because of how they work and may trigger allergic reactions making it even worse
Retinols
Topical retinol and retinoid treatments help speed up your skin’s natural cell turnover which helps the dark patches clear up more quickly than if left alone.
Skin bleaching agents
Hydroquinone is the most effective skin bleaching agent because they block melanin production. However, because of the side effects, hydroquinone should be used with a doctor’s supervision only on the pigmented areas. Hydroquinone creams should only be used for a few weeks at a time to prevent over-lightening of the skin.
‘’Hydroquinone and retinoid creams should be avoided in pregnancy as they could harm the foetus’’
Vitamin C
Some melasma sufferers have seen significant improvement when using high concentration vitamin c ointments with significant results. This is due to Vitamin C’s skin-brightening properties which reduce the pigmentations caused by melasma.
Other treatments
Some of the other recommended treatments include chemical peels, micro-needling and, laser treatments. Chemical peels can improve melasma by removing the outermost cells of the skin which contain the pigment. Micro-needling helps creams penetrate deeper into the skin. Some lasers remove the outer layer of skin while others target the pigment-producing cells (melanocytes). The success of laser therapy is variable, and there may be risks associated with this treatment, especially for people with dark skin.
Top Tips for control and prevention
- The most important thing you can do if you have melasma is to protect your skin from sun exposure. Avoid spending time in the sun when the UV index is at its peak between 11 am and 3 pm.
- Use a high SPF sun protection of at least 50 or 50+ and apply it at least 15 minutes before going out in the sun.
- Wear a hat if you are going outside for long.
- Have a good cleansing regimen to remove airborne pollutants which reduce skin integrity making it more susceptible to sun damage
- Use anti-oxidants like Vitamin C and E liberally they help heal damage from sunlight.
The most important aspect of preventing melasma is to apply sunscreen diligently since it is triggered by exposure to sunlight. Also, patience is key because it may take months for melasma to clear up.
Have you dealt with melasma? did it resolve on its own? Let me know what works and which of these treatments helped control your melasma?
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