632185 Health Library | Health and Wellness | Wellmont Health System
  • Melasma

    (Chloasma)

    Definition

    Melasma is a skin condition where brown patches appear on the skin. These patches usually appear on the cheeks, nose, forehead, chin, and upper lip. Patches can also appear on the neck and forearms.
    It is common during pregnancy but can happen in men and women.
    Common Site for Melasma
    AM00013 face
    Melasma usually appear on the face.
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The brown patches are due to an increased amount of melanin in the skin. The exact cause of increase in melanin is unknown. It is thought to be associated with hormones such as estrogen and progesterone. Sun exposure also plays a major role.

    Risk Factors

    Factors that increase your chance of melasma include:
    • Being a woman of reproductive age
    • Having a darker skin tone
    • Pregnancy
    • Getting too much sun exposure
    • Taking birth control pills
    • Using products that irritate the skin, such as cosmetics
    • Taking certain medicines, such as antiseizure medicines, or hormone therapy
    • Family history of melasma

    Symptoms

    The only sign of melasma is dark patches of skin. It is not painful or itchy.
    Not all brown patches on your skin are melasma. Talk to your doctor about changes in your skin.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. Your skin will be examined. A lamp, called a Wood’s lamp, may be used to look at your skin. A small sample of skin may be taken for a biopsy. The sample will be sent to a lab to confirm the diagnosis.

    Treatment

    Melasma may go away on its own. If it does not go away, it may need to be treated. In general, treating melasma can be difficult. Talk with your doctor about the best treatment plan for you.

    Removing Cause

    Factors that are causing the melasma may be removed. For example:
    • Melasma associated with pregnancy may slowly fade after giving birth
    • Melasma associated with birth control pills or hormone replacement therapy may fade after the medication is stopped
    It can reappear and become darker if you become pregnant again or resume taking medication.

    Ultraviolet Light Protection

    Protecting your skin from UV light is important in helping to fade melasma. This means avoiding sun and tanning bed exposure. Your doctor may recommend wearing sunscreen, clothing, and hats when outdoors.

    Depigmenting Medications

    Certain medicines, like bleaching creams, are used to lighten skin color. A common bleaching cream used to treat melasma is hydroquinone . This may also be used with other creams, like tretinoin, corticosteroids, azelaic acid or glycolic acid. These creams enhance the skin-lightening effect.
    Your skin may be sensitive to these medicines. Use care and start slowly when first using them. It may take several months before you see an improvement.

    Other Treatments

    Other treatments remove outer layers of the skin. Examples include:
    • Chemical peel
    • Microdermabrasion—removing top layer of skin
    • Laser therapy
    Along with treatment, avoid using products that can irritate your skin. These include make-up, creams, and cleansers.

    Prevention

    To help reduce your chance of getting melasma, take the following steps:
    • Limit the amount of time you spend in the sun. Avoid using tanning booths.
    • Use sunscreen daily. Wear sunscreen that protects against both UVA and UVB rays and has an SPF of 30 or more. Sunscreens containing zinc oxide and titanium oxide can be very helpful against melasma.

    RESOURCES

    The American Academy of Dermatology http://www.aad.org

    American Academy of Family Physicians Family Doctor http://familydoctor.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca/index-eng.php

    References

    Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol . 2006;55(6):1048-1065.

    Melasma. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/melasma. Accessed February 19, 2013.

    Melasma. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/skin/dermatologic%5Fdiseases/melasma.html. Accessed February 19, 2013.

    Melasma. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/melasma.html. Updated February 2011. Accessed February 19, 2013.

    Prignano F, Ortonne JP, Buggiani G, Lotti T. Therapeutical approaches in melasma. Dermatol Clin . 2007;25(3):337-342.

    Tierney EP, Hanke CW. Review of the literature: Treatment of dyspigmentation with fractionated resurfacing. Dermatol Surg . 2010 Oct;36(10):1499-508.

    Treatments of discomforts during pregnancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated January 23, 2013. Accessed February 19, 2013.

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