Melasma

Alternative names :- Chloasma; Mask of pregnancy; Pregnancy mask

A patchy, hypermelanotic skin disorder, melasma (also known as chloasma or mask of pregnancy) poses a serious cosmetic. although non-life-threatening problem. It darkens the facial skin, commonly affecting the cheeks. forehead, jaw line. and areas around the mouth. Although it tends to occur in all races, it's more common in darker skin types, especially Hispanics and Asians. Melasma affects females more often than males, occurring commonly in women during their reproductive years.

What causes Melasma?

The cause of melasma is unknown. Genetics may playa large role as more than 30% of patients have a family history of melasma. Histologically, hyper pigmentation results from increased melanin production. although the number of melanocytes remains normal. Melasma may be related to the increased hormonal levels associated with pregnancy, menopause, ovarian cancer, and the use of hormonal contraceptives or hormonal replacement therapy. Progestational agents. phenytoin and mephenytoin may also contribute to this disorder. Exposure to sunlight may stimulate melasma, but it may also develop without any apparent predisposing factor. Patients with acquired immunodeficiency syndrome have an increased incidence of similar hyperpigmentation. Another study found a fourfold increase in thyroid disease in patients with melasma. Thus, genetics and hormonal influences along with ultraviolet light are likely the major causes of melasma.

Signs and symptoms of Melasma

Typically, melasma produces large, tan-brown, irregular patches, symmetrically distributed on the forehead, cheeks, and sides of the nose. Less commonly, these patches may occur on the neck, upper lip, and temples.

Diagnosis information

Observation of characteristic dark patches on the face usually confirms melasma. The patient history may reveal predisposing factors.

Treatment of Melasma

Treatment consists primarily of application of bleaching agents; the most commonly used agents contain 2% to 4% hydroquinone (Esoterica) to inhibit melanin synthesis. This medication is applied twice daily for up to B weeks. Combination sunscreen and hydro quinone products also have been effective. Tretinoin ( Retin-A) can be used as monotherapy or with hydroquinone. Azelaic acid is as effective as hydro quinone in treating melasma. A new medication used for treating melasma, Tri-Luma, is a combination of hydro quinone, tretinoin, and fluocinolone acetonide (a potent topical steroid). Although Tri-Luma has been proven safe and effective, it's use is limited to no more than B weeks because it's a potent topical steroid that may cause skin atrophy.

Some patients resort to removing superficial pigmented skin cells, through exfoliation, chemical peels, microdermabrasion, and light freezing of the skin with liquid nitrogen. However, these methods may cause excess irritation and actually may cause an increase in skin pigmentation. Regardless of the form of treatment, patients with melasma must adhere to strict avoidance of exposure to sunlight, use of sunscreens, and discontinuation of hormonal contraceptives (if that's the underlying cause). Melasma associated with pregnancy usually clears within a few months after delivery.

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ALTERNATIVE THERAPIES

Some natural remedies are available, but their efficacy and safety haven't been fully evaluated and approved by the FDA. Kojic acid is a Japanese bleaching agent that's derived from fungal and organic plant materials. It helps reduce melanin formation and is widely used in Asian and ethnic bleaching products. Other natural remedies that have skin brightening qualities are bearberry and licorice extracts and vitamin C.

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Special considerations and Prevention

• Advise the patient to avoid sun exposure by using sunscreens and wearing protective clothing. Bleaching agents may help but may require repeated treatments to maintain the desired effect. Cosmetics may help mask deep pigmentation.
• Reassure the patient that melasma is treatable. It may fade spontaneously postpartum, with protection from sunlight, and after discontinuing hormonal contraceptives. Caution the patient that treatment may take months and lightening of the pigment may be gradual.
• Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles.
• Avoid irritating the facial skin. No strong soaps or abrasive cleaners - use only a mild soap or cleanser for washing.
• Deeper chemical peels run the risk of increasing pigmentation and causing uneven results, but may be recommended in severe cases.