Melasma is a skin disorder characterized by dark areas on the face (forehead, cheeks and upper lip) and is caused by a buildup of pigment (melanin) in the skin. The dark areas are usually symmetrical and have definite boundaries (similar on both sides of the face). It's known as "chloasma" or the "mask of pregnancy" when it happens during pregnancy.

Although people with melasma may be concerned about its appearance, it is a harmless condition that causes no other health problems. Melasma is a prevalent skin condition that affects up to six million women in the United States.

Types of Melasma

Melasma is classified as "epidermal," "dermal," or "mixed."

Epidermal melasma means the pigment (melanin) is in the more superficial layers of the skin called the epidermis.

Melasma in the deeper layers of the skin is known as dermal melasma. This distinction is significant because epidermal melasma responds to therapy more quickly.

Melasma Risk Factors

Although melasma can occur in men, it is most common in women, especially in women of Hispanic or Asian ancestry. If your relatives had melasma, you are also at greater risk of developing melasma.

Women are also at greater risk of developing melasma if they are pregnant, take birth control pills or take hormone replacement therapy.

People at risk of developing melasma will notice the patches becoming darker following exposure to sunlight.

Treatment for Melasma

Treatment results vary greatly among individuals. Your recommended treatment will depend primarily on your type of melasma: dermal or epidermal.

It may take time to respond to treatment, so be patient. Some people with epidermal melasma experience rapid improvement within four to eight weeks of starting treatment, while others may find that progress can take many months.

Medications for Melasma

The medications prescribed for melasma cause the skin to stop making melanin.

  • Hydroquinone is the most commonly used bleaching agent. It is available in low concentrations over the counter (2%) or as a prescription (4% or stronger). The 2% formulations can be useful once the melasma is under control, but the 4% formulations are usually used to initiate treatment.
  • Topical retinoids, such as tretinoin, are a form of vitamin A and may be used to increase the turnover of skin cells, speeding the growth of lighter-colored skin.
  • Azelaic acid (Azelex®, Finacea®) may help to slow the activity of melanocytes, the cells that make the dark pigment in the skin.
  • Tri-Luma is a prescription-only medication that has been FDA-approved cream for the treatment of melasma. Tri-Luma®combines three ingredients into one topical medication. The ingredients include tretinoin, hydroquinone and fluocinolone acetonide. Fluocinolone acetonide is a topical corticosteroid ("steroid cream") that reduces irritation and may also help skin lightening.

Procedures for Melasma

Your doctor may discuss various dermatologic procedures that may reduce the appearance of the dark patches, including chemical peels, dermabrasion or lasers. Fractional lasers have also been found to be particularly effective for some types of melasma.

Preventive Measures

Avoiding exposure to sunlight is an essential step in treating melasma and preventing its return. Sunlight is a powerful trigger of pigment formation in people susceptible to melasma. It is strong enough to counteract the effects of medications and can even cause issues through car windows or on cloudy days.

If you must be in the sun, take the following measures to prevent the sun from contacting your face:

  • Wear a hat with a brim.
  • Consider using a sun umbrella.
  • Avoid reflective surfaces that may cause the light to reflect onto your face, including water.
  • Apply sunscreen daily.

When selecting a sunscreen, consider the following:

  • Use one with zinc oxide or titanium dioxide. Formulations that are "micronized" may blend better with darker skin.
  • Use a sunscreen that protects against both UVA and UVB rays.
  • Use a sunscreen that is listed as SPF 30 or greater.

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