March 14, 2020 Melasma Explained: Symptoms, Causes, Treatments And Pictures
What Is Melasma?
Melasma, also known as ‘chloasma’, is a chronic skin pigmentation disorder that can cause dark patches on the skin, especially on the face and upper lip. This skin condition is thought to affect more than 5 million Americans, especially women with darker skin types.
To better understand this skin condition, let’s first define melasma. The word ‘melasma’ comes from the Greek root melas, which means ‘black’. The same root is in the word ‘melanin’ (skin pigment). Your skin color is based on the amount of melanin present in your cells.
Melasma occurs when your skin produces excessive amounts of melanin.
Melasma triggers, whether internal or external, stimulate an increased production of melanin that causes the dark patches on your skin.
Melasma most commonly occurs on the face, although it can also appear on the arms and back. Melasma on the face typically appears on the forehead, the upper lip, the chin, or cheeks. Melasma may appear as ‘macules’, which resemble freckles, as well as larger dark patches that feature irregular borders.
Melasma symptoms include:
- Symmetrical patches of dark, brown or greyish skin
- Enlarged melanin cells called melanocytes
- An increase in the number of melanin cells
- Abnormal accumulation of elastic tissue
- An increase in blood vessels in the face
Melasma unfortunately cannot be cured, but it can be effectively managed with sun protective measures and professional dermatologic care.
Who Gets Melasma?
Melasma occurs in about 1% of the general population (Ogbechie). However, this number can range between 9-50% in high-risk populations. The difference in prevalence may be attributed to an individual’s degree of sun exposure, geographic location, and genetics.
Women develop melasma at a rate disproportionately higher than men. Some studies have found a 9:1 ratio of female predominance (Hexsel) while others have found differences as high as 39:1 (Vazquez). This disparity is due to the naturally higher levels of estrogen in women’s bodies. Pregnancy and oral contraceptives – both of which increase the amount of estrogen in the body – can trigger melasma as well.
Genetics play a large role in the development of melasma. Women of Hispanic or Indian descent are especially prone. If you have family members who have melasma, you are more likely to develop the condition yourself. Studies have shown that more than half of people with melasma have a family history (Ogbechie).
Can men be diagnosed with melasma too?
Although rare, melasma can also affect men. The clinical presentation of melasma is very similar in men and women with dark brown patches and macules (freckle-like spots) that develop on the face, neck, shoulders, or upper arms. The major risk factors for developing melasma among men are sun exposure and performing work outdoors (Ogbechie).
Causes Of Melasma
As far as skin conditions go, melasma is not dangerous or painful, but it can be very troublesome all the same. So, what causes melasma? In truth, the exact cause is not known. However, there are several well-documented triggers.
- Internal factors include genetics (family history), having naturally darker skin, and hormone changes.
- External factors include UV light exposure, skin inflammation, irritation from certain toiletries or cosmetics, certain medications, and oral contraceptives.
- Pregnancy can also trigger this skin condition, earning melasma the nickname the ‘mask of pregnancy’.
What Are My Treatment Options?
Melasma is not a harmful condition, and some individuals choose not to seek treatment. However, scientific studies have consistently shown that melasma can negatively impact an individual’s quality of life both socially and professionally. But how can you treat this condition if it cannot be cured?
Melasma is very manageable, so seeking treatment can help reduce the appearance of dark patches as well as prevent these patches from coming back. There are many types of treatment, all of which can help fade and manage this skin condition.
- Topical creams: Combinations of medications that are applied to the skin which inhibit melanin production, encourage new skin growth, and reduce inflammation. These creams may include one or a combination of ingredients, such as kojic acid, azelaic acid, tranexamic acid, and hydroquinone.
- Chemical peels: A chemical solution that ‘peels’ off the topmost layer of skin, removing discolored patches and promoting new skin growth.
- Laser skin lightening: The use of precise lasers to remove discolored areas on the skin.
- Oral treatments: The use of oral medications to slow melanin production and improve the appearance of dark patches on the skin.
- Microneedling: The use of very small needles to help topical melasma creams penetrate more deeply into the skin to improve the appearance of dark patches.
- Microdermabrasion: The use of a specialized tool to exfoliate the skin, improve cell turnover, and promote new skin growth.
- Other treatments: Home remedies include apple cider vinegar, essential oils, turmeric, and others. These treatments are not well studied and should only be used following a consultation with your doctor.
No treatment plan is complete without sun protection because UV rays can make your melasma worse. All treatments should include at-home lifestyle modifications such as avoiding the sun during peak hours (10am – 2pm), wearing a broad-brimmed hat outdoors, and regularly applying a broad-spectrum sunscreen. Choose a sunscreen that contains either iron oxide or titanium dioxide (or even better, both). These ingredients are physical UV blockers that are particularly helpful in reducing the severity of the dark patches on your skin.
In addition, avoid using cosmetics or toiletries that irritate your skin since inflammation can cause your skin to become even darker.
Our Dermatologist worked closely with Musely and found The Spot Cream to be the best treatment on the market
Can Melasma Fade On its Own?
Although melasma can fade on its own without any treatment, these options may take time. At-home, prescription-free remedies include avoiding the sun and wearing UV-rated clothing. Where this condition is caused by hormonal birth control pills or IUDs, stopping the use of these contraceptives can help dark patches fade. When pregnant women develop melasma, the dark patches generally fade after giving birth.
How Might Melasma Be Prevented?
Unfortunately, melasma is often caused by uncontrollable factors such as skin type, genetics, and gender. However, prevention is still a critical component in dealing with existing melasma regardless of the type of treatment you use. While the condition is caused by a variety of factors, one which is both highly culpable and preventable is direct exposure to ultraviolet sunlight. It is responsible for aggravating existing hyperpigmentation and undoing the progress you have made towards achieving a clear complexion.
Any effective melasma treatment includes the daily use of a broad spectrum sunscreen. Sunscreen labeled as such has been required by the FDA since 2011 to protect against the two types of UV radiation (A and B) that are linked to the kind of skin damage linked to melasma.
Notably, UVA—the radiation most responsible for the kind of damage linked to melasma—is present during all daylight hours, and it is as present in direct sunlight as it is with overcast. This means that sunscreen is warranted at unintuitive moments, and it should likely be used more often than not.
Research suggests that physical UV blockers like iron oxide result in a lower melasma relapse rate over broad spectrum sunscreens that do not contain sunlight blockers.
Can you prevent melasma?
Before And After Photos
ClearifiRx has helped many patients improve their complexion and manage their melasma with long-term results. One of the most important things to keep in mind when it comes to treating melasma successfully is that this condition can be notoriously slow to respond to treatment. However, with diligent use of our melasma cream and sun protective measures, we’re confident you will see noticeable improvements. Many of our patients report improvements within weeks of the first treatment and clear skin following after several months.
Our melasma treatment before and after photos demonstrate how we’ve helped our patients brighten up their complexion.
Melasma does not discriminate about who it affects, and many celebrities have this bothersome skin condition too.
Celebrities with melasma include:
- Jenna Dewan Tatum
- Drew Barrymore
- Molly Sims
- Sarah Silverman
- Brooke Burke
- Balkrishnan R, Kelly AP, McMichael A, Torok H. Improved quality of life with effective treatment of facial melasma: The PIGMENT trial. J Drugs Dermatol 2004;3: 377–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025517/
- Breaking Down Broad-Spectrum Protection. The Skin Cancer Foundation. https://www.skincancer.org/blog/broad-spectrum-protection-sunscreen/. Published June 28, 2018. Accessed March 18, 2020.
- Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771–782. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155956/
- Hexsel D, Lacerda DA, Cavalcante AS, Machado Filho CA, Kalil CL, Ayres EL, et al.Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol. 2014;53(4):440–4 (PubMed PMID: 23967822). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155956/
- Jiang J, Akinseye O, Tovar-garza A, Pandya AG. The effect of melasma on self-esteem: A pilot study. Int J Womens Dermatol. 2018;4(1):38-42. https://www.researchgate.net/publication/321701268_The_effect_of_melasma_on_self-esteem_A_pilot_study
- Melasma: Diagnosis and treatment. American Academy of Dermatology. https://www.aad.org/public/diseases/color-problems/melasma#causes. Accessed April 10, 2020.
- Ogbechie-godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb). 2017;7(3):305-318. https://www.ncbi.nlm.nih.gov/pubmed/28726212
- Palmer WJ. Tranexamic acid for melasma. Dermatology Times. https://www.dermatologytimes.com/melasma-and-hyperpigmentation-treatments/tranexamic-acid-melasma. Published November 20, 2018. Accessed April 10, 2020.
- Sheth, Vaneeta M. et al. Melasma: A comprehensive update. Journal of the American Academy of Dermatology, Volume 65, Issue 4, 689 – 697. https://www.jaad.org/article/S0190-9622(11)00309-4/fulltext
- Sofen B, Prado G, Emer J. Melasma and Post Inflammatory Hyperpigmentation: Management Update and Expert Opinion. Skin Therapy Lett. 2016;21(1):1-7. https://www.ncbi.nlm.nih.gov/pubmed/27224897
- Vazquez M, Maldonado H, Benmaman C, Sanchez JL. Melasma in men. A clinical and histologic study. Int J Dermatol. 1988;27(1):25–7 (PubMed PMID: 3346120). https://www.ncbi.nlm.nih.gov/pubmed/3346120
About the author
Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the ...