Melasma

Melasma is a skin condition. It does not spread from person to person (non-contagious). Melasma is an area of tan or brown coloring that usually appears on the cheeks, forehead, upper lip and neck. These patches can look like a mask. The discolored area do not itch and are not red or swollen. This usually occurs in women with skin that colors (pigments) easily and also women of light brown skin color. It often occurs with pregnancy, menopausal women on hormone replacement, with liver disease or taking oral contraceptives especially when followed by sun exposure. It can also occur in men and nonpregnant women. It is more common in tropical climates.

CAUSES

  • Increase in pigment producing cells (melanocytes) in the skin.

  • Becoming pregnant.

  • Women on oral contraceptives.

  • Menopausal women on hormone replacement treatment.

  • Increase exposure to the sun in women with light brown skin.

  • It can be hereditary.

  • Allergies to medications or cosmetics.

  • Thyroid disease.

  • Addison's disease (loss of function of the adrenal gland).

  • Excessive stress.

SYMPTOMS

There are no symptoms except for the discolored skin with dark or tan blotches.

DIAGNOSIS

  • Melasma is diagnosed based on its physical appearance.

  • Wood's lamp to examine the discolored skin.

PREVENTION

To lower the risk of melasma, a woman can avoid oral contraceptives, hormone replacement treatment in menopause and stay out of the sun.

PROGNOSIS

There are no long-term effects from melasma. Using strong sun block may help.

TREATMENT

  • Bleaching creams, skin care products, peels that contain glycolic acid, skin peels and sunscreens that extend into the UVA blocking range are all helpful in the treatment of melasma.

  • The darkened skin of melasma usually fades somewhat after a woman gives birth or stops using oral contraceptives.

  • Specific products used to treat the melasma may have side effects. Some people may have a mild allergic reaction to the cream or bleach.

  • Using a combination of hydroquinone and glycolic acid, prescription or over-the-counter medicines. Follow the advice of your caregiver.

  • Tretinoin. This should not be used when pregnant.

  • Azelaic acid 20%.

  • Facial peels with alpha hydroxy acids or chemical peels.

  • Laser treatment.

  • Cosmetic cover-ups are available.

Avoid sunlight during all of these treatments.

HOME CARE INSTRUCTIONS

  • Problems which are getting worse should be reported to your caregiver.

  • Avoid overexposure to the sun, especially in tropical areas.

  • Use a strong sun block cream when you are in the sun.

SEEK MEDICAL CARE IF:

  • You develop skin blotches and want to get them checked out.

  • You want to know what kind of treatment you can use for the skin blotches.

  • If you have skin blotches and they are getting worse with or without treatment.

  • You notice bleeding from the skin blotches.