Melasma – Types and Treatment

Understanding Melasma

Melasma is a skin problem that makes the facial skin look symmetrically blotchy. It is a brownish pigmentation that appears on the face and is also known as chloasma or green skin. This however is only a cosmetic problem and does not have any other deep medical issues. The melanocytes or the pigment cells in the skin are overproducing melanin and hence the condition.

Occurrence of Melasma

Melasma is a common, acquired, progressive and non-scaling hyper pigmentation disorder that generally occurs in the region of the face especially on the cheeks, central face forehead, upper lips, nose, bridge of the nose, and chin, more frequently seen around the eyes. In short it occurs in areas where the skin is exposed to the sun. Melasma appears to resemble age spots but covers larger areas of darkened skin. It also can appear on other parts of the body that get lots of sun, such as the hind side of the forearms and the back of the neck.

Distribution Pattern

Melasma is typically distributed in any one of these patterns:

1. 63% occurrence is around the nose and chin area.
2. 21% over the cheeks and nose areas of the face.
3. 16% known to occur around the lower jaw.
4. Occurs very commonly in people who have darker skin or light brown skin where intense solar ultraviolet radiation exists. Thus people from East and south East Asian and Hispanic regions are prone to develop Melasma. It is more common in women than in men (9:1) and is rare before puberty, occurring most commonly in women of reproductive age.
5. It is also known to affect 80% of pregnant women, and hence often referred to as the “Mask of Pregnancy”.  

Types of Melasma

Melasma can be one of three types:

• Epidermal or on the outermost layers of cells on the skin
• Dermal. Melasma occurs in the layer that lies between the epidermis and the subcutaneous layers of the skin
• Mixed refers to presence of Melasma in the epidermis as well as the dermis.

Color and Appearance

• Melasma occurring in the epidermis is light brown in color and this discoloration appears to be darker when viewed under a wood lamp.
• Dermal Melasma is grayish in appearance and does not appear darker when viewed under a wood lamp.
• The mixed type of Melasma is dark brown and when examined under a wood lamp, may either appear to be darker or there may be no change.

Causes

1. Harmful and overexposure to the Sun
2. Pregnancy - fades a few months after delivery
3. Hormone treatments including oral contraceptive pills containing estrogen and or progesterone, hormone replacement, intrauterine devices and implants.
4. Scented or deodorant soaps, toiletries and cosmetics which can provoke Melasma which can then persist long-term.
5. Phototoxic reactions to certain medications.
6. Melasma has also been associated with hyperthyroidism. 

Treating Melasma - Results and Precautions

It is important to first distinguish the type of Melasma present as:

1. Epidermis Melasma which occurs superficially or on the surface of the epidermis is the most easily treatable types of Melasma.
2. The Dermal Melasma is more deep rooted and therefore does not respond to bleaching agents. Dermal Melasma has no defined borders unlike Melasma present on the Epidermis where the borders are clearly defined. Dermal Melasma does not respond too well to treatment.
3. The mixed type of Melasma generally improves with treatment.
4. Discontinuation of any hormonal contraception.
5. Year round protection from the sun

The ideal treatment for a quick result is just to destroy the pigment, while leaving the cells alone. Laser Therapy is by far the best.