March 15, 2019 What Exactly Causes Melasma?
At this time, the exact cause of melasma is still not known. However, we do know that there are certain well-known triggers that can contribute to the development of this chronic hyperpigmentation issue. Let’s talk about what these triggers are.
Genetics And Gender
Susceptibility to melasma is polygenic, meaning there are many different inherited genetic factors that contribute. For example, people who have darker skin types have a greater chance of developing melasma.
- Melasma can run in families. Studies have demonstrated that almost half of women with melasma have a family member who is also affected. So, if you are a woman and your mother has melasma, there’s a greater chance you may develop this condition too.
- Your gender is another large factor that can cause melasma. Melasma is more common in women than in men. While the numbers vary from population to population due to factors such as skin type and sun exposure, studies have found female-prevalent ratios ranging from 6:1 to as high as 39:1. Men with this skin condition generally find that their melasma is triggered by sun exposure.
One of the most common triggers for melasma is sun exposure. There are several suggested explanations for why this is the case, but they all can be summarized by stating that UV rays from the sun cause the release of certain ‘pro-inflammatory’ chemicals that excite the melanocytes in the skin into overproducing pigment. This increased pigment production can give your skin a tan, but it can also make your melasma flare or get darker.
That’s why people often notice that their melasma is triggered by times when they are exposed to a lot of sunlight.
In addition to sun exposure, very strong artificial light can also make your melasma worse. Individuals who work under these kinds of lighting situations can have difficulty treating melasma. Heat, scientifically known as infrared radiation, can also worsen melasma.
Hormones are a common, well-known melasma trigger, even though the connection is not yet fully understood. It’s thought that pigment-making skin cells have receptors that can bind with estrogen and progesterone.
Part of the reason that women develop melasma more frequently than men is because of their naturally higher levels of estrogen in the body.
When estrogen acts on melanocytes (pigment-producing cells), the skin produces more pigment. Estrogen also increases the number of melanocortin receptors in the skin, which makes melanocytes more sensitive to sun and inflammation. Estrogen also increases the amount of a pigment-forming enzyme called tyrosinase in the body.
Individuals with melasma have greater numbers of progesterone receptors in the affected areas of skin. This means that these individuals have skin that is particularly sensitive to increased progesterone levels.
About 25% of women will develop melasma as a direct result of taking birth control, and of these, about 90% will also experience a worsening of melasma during pregnancy.
There’s a reason this skin condition is nicknamed the ‘mask of pregnancy’, after all! Both pregnancy and hormonal birth control increase the amount of estrogen in the body, which causes skin hyperpigmentation as outlined above. Women who develop melasma with hormonal birth control are likely for melasma to worsen with pregnancy.
Other Potential Causes Of Melasma
As we mentioned above, the exact causes of melasma are not yet fully understood. In addition to the causes above, there are a few less well-known causes of melasma.
While psychological stress isn’t a skin irritant per se, it is considered to be a possible melasma trigger by some researchers. Stress causes your body to increase the hormone cortisol, which can in turn influence the amount of estrogen in the body. So, take it easy on yourself – and on your skin!
The thyroid gland is located in the mid-lower neck and plays a crucial role in the endocrine system of the body. It releases a substance called ‘thyroxine’ which plays a crucial role in the proper functioning of many cells in your body, including your muscles, heart, digestive system, hair, and – you guessed it – skin.
Studies looking into the less known triggers of melasma found that among patients with hyperpigmentation, 20.3% had thyroid dysfunction.
Certain medications and skin products
Research has shown that taking medications, specifically those for seizure prevention known as ‘anticonvulsants’, have been associated with flares of melasma.
Inflammation caused by skin irritants is one of the most studied reasons for melasma. Skin irritants include certain fragrances, soaps, and cosmetics. For individuals who have melasma due to their genetics, gender, and skin type, the use of these products can cause inflammation, which in turn may trigger a melasma flare.
Since cosmetic camouflage is invaluable when it comes to hiding dark patches, choose products that are unscented and are gentle on the skin to prevent skin irritation.
Although chemical peels and lasers can help improve the appearance of melasma in some people, these same treatments can make melasma worse in others. Consult with your dermatologist to determine if these treatments are right for your skin.
Can Hydroquinone Cause Melasma?
Some people have claimed that hydroquinone, a common ingredient in many melasma-blasting creams, triggered their melasma. We’re here to tell you that this is not the case at all. Hydroquinone works by blocking an enzyme called tyrosinase from producing skin pigment.
That said, using this ingredient for too long can actually cause the skin to darken in a process called ‘exogenous ochronosis’. Professional dermatologic care can help you avoid this side effect.
- Melasma treatment options: What works and what to avoid?
- Hydroquinone + Retinoid + Steroid = Safe Treatment
- Side Effects of Common Melasma Treatment
- Can Spironolactone Cause Melasma?
- Why Does Hyperpigmentation Affect Some People And Not Others?
Custom At-Home Melasma Treatments With ClearifiRx
While an understanding and avoidance of these potential triggers is of vital importance, it is not always possible to prevent melasma from happening. If you do experience a flare of your melasma, it is crucial to get evaluated by a qualified physician such as those available via ClearifiRx.
We deliver custom, prescription-strength melasma treatments directly to you.
Your personal clinician will assess your melasma and create an ongoing treatment plan that is optimized to your skincare needs. This plan will include prescription-strength melasma creams delivered to you, online consultation with a licensed clinician, and recommendations to help you protect your skin from UV rays.
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About the author
Neal Kumar, MD, MBA did his undergraduate training at the University of North Carolina at Chapel Hill with a major in Biology and minors in Chemistry and Entrepreneurship, and was also selected as a Carolina Entrepreneurial Fellow.
He received his Doctor of Me...