Melasma, also known as chloasma and the ‘mask of pregnancy’, is an acquired brown macular hyper pigmentation, usually of the face. It is nine times more common in females than males.

Melasma usually presents bilaterally and symmetrically on the face, but extensor forearms may also be involved. Sun exposure, pregnancy and oral contraceptive pills have all been associated with its presentation. There are three types of melasma including: epidermal, dermal and mixed variants.

Melasma is a common pigmentary disorder. Women of Mediterranian and Asian origin get this condition commonly at puberty or later. Darkly pigmented races from India, Pakistan, and the Middle East can develop this condition very early in life.

Melasma Before and After

*Un-retouched photos

Melasma Cause

The exact cause of melasma is unknown, but several factors that contribute its development:

Melasma Clinical Patterns

There are three types of melasma patterns which do predict how the melasma may spread. The three patterns are:

Sun Damaged Skin

The appearance of sun-damaged skin is well recognized and is noticeably different from changes seen with normal aging making the person appear much older that they are. The very smooth, fine, pale wrinkling associated with aging seen in the sun-protected areas of the body such as the buttocks and stomach are different from areas that have unprotected exposure to the sun such as the face, neck, chest and hands.

Fine and coarse wrinkles are seen on sun-damaged skin. The skin can feel extremely rough and appears loose or lax. Increased pigmentation is seen and the skin looks patchy and mottled. Sometimes these patches become irregular and produce what are known as lentigos. In areas around the back of the neck a leathery texture and coarseness with deep lines is frequently seen. The skin may feel dry and scaly. Chronic sun exposure will in many produce a thickened layer in the upper dermis known as solar elastosis, which gives a yellowish thickened look. The skin appears dull and unhealthy.

Some individuals will develop more blood vessels, known as telangiectasias, spider veins or broken blood vessels. These can be treated effectively by laser treatments. If the damage is severe, thinning of the skin and bruising may be seen particularly on the hands and forearms.

Treatment for Melasma and Sun Damage

Treatment for Sun damaged skin and melasma begin with the use of a broad spectrum sunscreen that blocks UVA and UVB is essential. The most common depigmenting agent is hydroquinone which can be found in Obagi Skin Care Product which is physician only. Hydroquinone works by turning off the cells that make melanin. Retin-A and azelaic acid may be used alone or in combination with hydroquinone to reduce epidermal pigment, but they should not be used in pregnancy.

Chemical peels may be considered in lighter-complexioned patients only because the peel can cause a reactive hyperpigmentation in darker-complexioned patients. Fraxel laser treatments have also been medically and clinically proven to be effective for sun damaged/Melasma. Combination therapies of Obagi Skin Care and Reliant Reliant Fraxel treatments are an extremely effective therapy in controlling and improving melasma and skin that has been damaged by unprotected UV radiation.