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Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip. Melasma mostly occurs in women. Dark-skinned people, particularly Hispanics, Asians, Indians, people from the Middle East, and African Americans, tend to have melasma more than others.
The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop it themselves. Changes in hormonal status may trigger melasma. It is commonly associated with pregnancy and sometimes called the “mask of pregnancy.” Birth control pills may also cause melasma, however, hormone replacement therapy used after menopause has not been shown to cause the condition. Sun exposure and very strong light from light bulbs contributes to melasma. Any irritation of the skin may cause an increase in melasma in dark-skinned. Because melasma is common, most patients can be diagnosed simply by a skin examination.
While there is no cure for melasma, many treatments have been developed. Melasma may disappear after pregnancy, it may remain for many years, or a lifetime. Sunscreens are essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. A SPF 30 or higher should be selected. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors. A significant amount of sun exposure is received while walking down the street, driving in cars, and sitting next to windows.
A variety of bleaching creams are available for the treatment of melasma. These creams do not “bleach” the skin, but rather, decrease the activity of these pigment-producing cells. Over-the-counter creams contain low concentrations of bleach. This is often effective for mild forms of melasma.
Until recently, there has been no effective laser treatment for melasma. The recent FDA approval of the Fraxel laser for treatment of melasma is a highly effective and safe procedure for all skin types and especially for those individuals who have tried other treatments such as topical bleaching agents and peels without success.
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