Melasma is a skin condition characterized by patches of brown, blotchy pigmentation on the face. It is also known as chloasma. Causes for melasma include genetic predisposition, pregnancy, use of oral or injected hormonal contraceptives, use of hormone replacement therapy, sun exposure, and sensitivity to chemicals found in toiletries, cosmetics and soaps. While there is no reliable permanent cure for the condition, a number of treatments are available to diminish its effects.
According to the Merck Manuals Online Medical Library, melasma is painless and will most likely occur on both sides of your face. The most commonly affected areas are the center of your face, upper lip, nose, forehead and cheeks. In some cases, the condition may be limited to one side of your face, and in rare situations may also extend to your forearms.
Initial Treatment Options
A number of different factors may contribute to your melasma, and effective relief may require a combination treatment approach. Begin by diminishing your exposure to direct sunlight. Use sun protection throughout the year, either in the form of a high sun protection factor (SPF) sunscreen or a sunscreen-containing makeup. If you use a hormone-based contraceptive, discontinuing its use may ease your symptoms. You may also gain relief from discontinuing hormone replacement therapy. If your melasma develops during pregnancy, there is a good chance it will disappear on its own once you have given birth. Fading of melasma splotches after hormone use or pregnancy may take several months or longer.
You can sometimes prevent the formation of melasma by inhibiting the pigment-producing cells (melanocytes) in your skin. Treatment options include the prescription skin-bleaching medications hydroquinone, retinoic acid, kojic acid and azelaic acid. Your doctor may also prescribe hydrocortisone or other topical corticosteroids.
Other treatment techniques work by peeling off skin affected by melasma. Options include the use of salicylic acid creams and topical alpha hydroxyacids such as lactic acid or glycolic acid, which can be used as either creams or chemical peels. If you are not pregnant, your doctor may prescribe tretinoin or another topical medication from the group of vitamin A derivatives called retinoids. In some cases, your doctor may also recommend either dermabrasion or microdermabrasion, two procedures that involve surgical scraping of your skin's top layers. However, these techniques must be performed with care, since damaging the melanocytes in these skin layers can actually cause increased pigment production and darken your skin further. Laser resurfacing uses a controlled laser beam to scrape away your skin's surfaces, but the results of this treatment may also vary widely.
According to the New Zealand Dermatological Society, complete relief from melasma is relatively rare. Roughly 30 percent of individuals gain an initial remission of symptoms from use of combined medications. However, environmental and hormonal factors make the return of symptoms possible even in these cases. Consult your dermatologist (skin specialist) for more information on melasma treatment options.
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