Melasma is a skin condition characterized by brown or blue-gray patches or freckle-like spots. It is often called the “mask of pregnancy.” Melasma happens because of overproduction of the cells that make the color of your skin. It is common, harmless and some treatments may help. Melasma usually fades after a few months.
What is melasma and what does it look like?
Melasma is a common skin disorder. Loosely translated, the word means “black spot.” If you have melasma you are probably experiencing light brown, dark brown and/or blue-gray patches on your skin. They can appear as flat patches or freckle-like spots. Commonly affected areas include your face, including the cheeks, upper lip, and forehead, as well as the forearms. Melasma is sometimes called the “mask of pregnancy” because it frequently affects pregnant women. Melasma typically darkens and lightens over time, often getting worse in the summer and better in the winter.
Another, less common name for melasma, is chloasma. Although this disorder is completely harmless, it understandably makes some people feel self-conscious.
What happens in the skin?
Your skin is made up of three layers. The outer layer is the epidermis, the middle is the dermis, and the deepest layer is the subcutis. It is an organ – the largest organ – and it makes up about one-seventh of your body weight. Your skin is your barricade. It protects your bones, muscles, organs, and everything else from the cold, from germs, sunshine, moisture, toxic substances, injury and more. It also helps regulate your body temperature, prevent hydration, and feel sensations like the warmth of the stove, the fur on your dog’s belly and the pressure of someone else’s hand holding yours.
Your epidermis contains cells called melanocytes that store and produce a dark color (pigment) known as melanin. In response to light, heat, or ultraviolet radiation or by hormonal stimulation, the melanocytes produce more melanin, and that is why your skin darkens.
What are the types of melasma?
There are three types of melasma, and they have to do with the depth of the pigment. A Wood’s lamp that emits black light may be used to determine the depth of the pigment. The three types are:
Epidermal: Epidermal melasma has a dark brown color, a well-defined border, appears obvious under black light and sometimes responds well to treatment.
Dermal: Dermal melasma has a light brown or bluish color, a blurry border, appears no differently under black light and does not respond well to treatment.
Mixed melasma: Mixed melasma, which is the most common of the three, has both bluish and brown patches, shows a mixed pattern under black light and shows some response to treatment.
What causes melasma?
There are two main causes of melasma: radiation, whether ultraviolet, visible light, or infrared (heat) light; and hormones.
Ultraviolet and infrared radiation from the sun is key in making melasma worse. Other possible causes of melasma include:
Antiseizure medications: Drugs that prevent you from having seizures may be a cause of melasma. An example of an antiseizure medication is Clobazam (Onfi®).
·Contraceptive therapy (birth control): Melasma has been observed in individuals who use oral contraceptive pills that contain estrogen and progesterone.
Estrogen/Diethylstilbestrol: Diethylstilbestrol is a synthetic (man-made) form of the hormone estrogen. It is often used in treatments for prostate cancer. Again, there is a pattern between increased estrogen and melasma.
Genetics: About 33% to 50% of people with melasma have reported that someone else in the family has it. Most identical twins both have melasma.
Hypothyroidism: A condition where your thyroid is underactive.
LED Screens: Melasma may be caused by the LED lights from your television, laptop, cell phone and tablet.
- Pregnancy: It is unclear why “the mask of pregnancy” happens to pregnant women. However, experts theorize that the increased levels of estrogen, progesterone, and the melanocyte-stimulating hormones during the third trimester of pregnancy play a role.
- Hormones: Hormones like estrogen and progesterone may play a role in some people. Postmenopausal women are sometimes given progesterone and have been observed developing melasma. If you are not pregnant, you likely have elevated levels of estrogen receptors found in your melasma lesions.
- Makeup (cosmetics): Some cosmetics can cause what is called a phototoxic reaction.
- Phototoxic drugs (medicines that make you sensitive to sunlight): These include some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycaemics, antipsychotics, targeted therapies, and some other drugs.
- Skin care products: A product that irritates your skin in general will likely make your melasma worse.
- Soaps: Some scented soaps are thought to cause or worse melasma.
- Tanning beds: The UV light produced by tanning beds damages your skin just as bad as the UV light from the sun, and sometimes worse.
What are the signs of melasma?
Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. Sometimes the patches can become red or inflamed. Melasma appears in six locations or a combination of locations on your skin:
- Brachial: The melasma appears on your shoulders and upper arms.
- Centrofacial: The melasma appears on your forehead, cheeks, nose, and upper lip.
- Lateral cheek pattern: The melasma appears on both cheeks.
- Malar: The melasma appears on your cheeks and nose.
- Mandibular: The melasma appears on the jawline.
- Neck: In people aged 50 or older, melasma can appear on all sides of the neck.
Your healthcare provider will decide for sure if you have melasma or another type of skin disorder.
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Melasma is common, normal, and harmless, but it can be bothersome. This skin disorder can affect your social life if you are feeling self-conscious about it. But you do not have to just “live with it.” There are treatment options. There are preventative measures you can take. There are dermatologists who can help you. Ask them questions and voice your concerns.
Always listen to the advice of your healthcare provider and follow your treatment plan carefully.