What is Melasma, Hyperpigmentation, dark spots on facial skin

Melasma, hyperpigmentation, dark spots on Facial Skin

Melasma is a skin problem which causes brown to gray-brown patches on the face. 90% of the affected are females while only 10% of them are males. Generally, people with darker skin types than lighter types skin types (especially light brown) are more commonly affected than lighter skin types. People from areas with high sun exposure are more prone to melasma.

In India, 20-30% of 40-65 years old women suffer from melasma. Melasma is also referred as ‘mask of pregnancy’ since pregnancy is a common cause of melasma.

Chloasma is sometimes synonymous term used for melasma during pregnancy.

What causes melasma??

Causes of melasma includes hormonal changes, pregnancy, exposure to ultra- violet radiation, visible light or infrared radiation, as a side

Effect of contraceptive therapy - due to estrogen (a female sex hormone), thyroid diseases like hypothyroidism, genetic influences, exposure to heat, over or unsafe use of cosmetic products, prolonged intake of anti seizure medications.

Sun exposure – being one of the commonest factors to cause melasma, it induces production of melanocyte producing hormone which increases melanin production by melanocytes.

Pregnancy – increase in female Sex hormones like estrogen & progesterone is believed to be a factor to cause melasma. As mask of pregnancy is known to occur in obstetric patients.

Hormonal changes – estrogen acts on skin cells which in turn stimulates melanocytes & increased amount of tyrosinase (pigment forming enzyme) produces even more melanin pigments resulting in a skin highly sensitive to sun exposure. This results into dark patches on the skin on prolonged sun exposure also women in post menopause may develop melasma if progesterone level gets increased.

Usage of certain skin care products – some of the cosmetic products can irritate your skin and cause discoloration

Led lights – blue lights from prolonged screen time can also cause melasma

How is melasma caused??

As hormonal changes occur in the body, melanin production is boosted which results into appearance of Dark patches on the skin.

Increased blood flow to the skin than that is required due to many reasons, viz, inflammation, heat, UV/infrared radiation, can also flare up melasma.

How melasma appears??

It mostly appears on the face over cheeks, forehead, above the upper lip, over the nose bridge. Although it can sometimes also appear on shoulders, upper arm, jawline or neck. It appears as light brown, Dark brown or bluish patches on the skin. The color of pigmentation can vary on the skin type of an individual and severity of the condition.

The discolored patches of melasma typically appear flat and they appear darker than the surrounding skin.

They do not feel itchy or painful.

Some cases of melasma can be mistaken as freckles as it can also form small spots on the skin. Whereas, melasma causes larger patches than the usual freckles.

How melasma differs from hyperpigmentation?

Hormonal aspect differentiates melasma from hyperpigmentation. Based on its appearance and location, melasma typically appears as blotchy patches on the areas exposed to light. Due to this reason melasma worsens during summer. While hyperpigmentation, is a sign of sun damage or dysregulation of pigment production in the skin. It covers smaller areas on the face or can be expansive and cover the face, Trunk, or extremities.

How to prevent melasma??

Always apply sunscreen with minimum SPF 30 before sun exposure even on cloudy days and in the winter.

Physical sunscreens containing zinc & titanium dioxide should be preferred than chemical ones.

Irrespective of the weather, cover the exposed part of the face using use hat or cotton clothing, sunglasses to avoid direct sun exposure, especially during peak hours in the afternoon .

Follow a proper skin care routine prescribed by the doctor, suitable to own skin type that contains a daily usage of cleanser, moisturizer, sunscreen.

Use gentle, non-irritating cleanser.

Always moisturize your skin after cleansing.

Adding antioxidants containing serum to your skin care routine can heal damage from sunlight.

Avoid exposure to heat and humidity.

Eat a balanced healthy diet & exercise regularly, also sleep for enough hours to get sufficient rest.

What are the treatment options available for melasma??

Skin exfoliation – It removes outermost layer of skin, which results into a clearer and more even skin tone.

Treatments done for exfoliating skin are chemical peels, microdermabrasion, laser skin resurfacing

Chemical peeling – they are Extremely effective in melasma. Based on the evaluation of patients’ skin type and severity of melasma, type of chemical peeling is selected by the doctor. Priming of the skin is essential in melasma for a minimum period of four weeks before the peeling procedure. Mostly useful peels in cases of melasma are glycolic acid and salicylic acid peels.

Microdermabrasion – microdermabrasion is seen to enhance efficacy of chemical peels.

Skin stimulation – It promotes skin regeneration which restores even skin complexion.

Treatments does for stimulating skin are micro needling, intense pulsed light therapy.

Micro needling – Micro needling By Itself, Without any Other Topical Skin lightening agents, does not have a strong evidence base for improving melasma. Microneedles form direct pores through the top layers of skin to deliver medications into the dermis. As an adjunctive treatment for

Melasma, micro needling is used alongside other agents like hydroquinone creams, topical retinoid, vitamin c serums.

Intense pulse light therapy – In this treatment, using varying frequencies, pulse duration and a wide spectrum of light is used to target affected areas in the skin. Its effectiveness depends on different variables, from frequency to combined use with topical treatments. Depending on the case, pill needs to be correctly chosen treatment option, if Inappropriate option is selected, it may worsen the condition.

Melasma is a skin condition in which the patient needs to keep patience for continuing the line of treatment prescribed by the doctor. One should never discontinue the ongoing treatment, as it affects one’s confidence due to it’s effect on esthetics, for treating melasma, always consult your doctor before starting any skin care treatment. Avoid any home remedy for any type of skin Condition by yourself.

Dr Sakshi C Barethiya (Costmetologist/ Skin care consultant)