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Melasma, also known as chloasma, is a common skin condition that causes brownish-gray patches on the face. It mostly affects people with darker skin, such as Latinos, Hispanics, African Americans and many from North Africa, Asia, India, the Middle East and the Mediterranean. Women are more susceptible than men. The prevalence rate varies depending on one's location. Those who live in warm, sunny climates and have darker skin are more apt to develop melasma than those with fair skin living in cooler climates. It usually appears in people between 20 and 40 years old.
Symptoms of melasma
Melasma causes patchy, brown, gray or blue-gray discoloration of the skin. The most common areas where it develops are the forehead, cheeks, chin, bridge of nose, and above the upper lip. It is symmetrical, appearing the same on both sides of the face. The patches do not cause any physical discomfort; there isn’t any pain, itchiness, or other physical sensations. But it can cause embarrassment, shame, distress, and lowered self-esteem.
The exact cause of melasma is not completely understood, but genes do appear to play a role. According to a clinical review published in Anais Brasileiros de Dermatologia in 2014, about 40 percent of people with melasma also have a relative with the condition.
There are also some common triggers, including:
- _Hormones _: Melasma is very common during pregnancy, often showing up in the second or third trimesters. Women who take hormonal contraceptives or hormone replacement therapy are also at a higher risk of developing it, according to the American Academy of Dermatology.
- _Sun exposure _: While melasma isn’t caused by sun exposure, it can be more apparent after being outdoors in the sun. The dark patches often fade during the winter months.
- _Some cosmetics _: Cosmetics and skin care products that contain irritants, such as perfumes, can trigger melasma in some women.
While scientists don’t fully understand the underlying causes, they do know that it is not an infection, it is not contagious, it is not an allergy, and it is not, nor will it become, skin cancer.
There isn’t a cure for melasma. However, there are a number of treatments that can lighten the skin. Because there are no physical sensations, if the darker skin is limited to a small area or does not bother you, there is no need for treatment. The best protection is to protect yourself from sun exposure by wearing a wide brimmed hat and sunscreen everyday. But again, that is no guarantee against the condition.
You might not need treatment if your melasma is triggered by pregnancy or hormone treatments, including birth control. Once the pregnancy is over or you have stopped the hormone treatment, the dark patches tend to fade.
The choice of treatment depends on how deep the excess pigment in the skin. It can be limited to the epidermis, or uppermost layer of the skin, or can be located deeper. Your dermatologist will examine your skin to determine the depth of the pigment and the best treatment for you. According to the American Osteopathic College of Dermatology, melasma that is limited to the epidermis is much easier to treat.
Skin lightener creams containing hydroquinone can help. These are available by prescription or, at lesser strengths, over the counter. If this treatment alone does not help, your dermatologist might add a second or third medication. Corticosteroid cream is often added as a second medication. Another medication, tretinoin, can be added as a third medication. There are prescription creams that contain all three medications.
If topical treatments have not brought about results, your dermatologist might recommend procedures such as chemical peels, microdermabrasion, dermabrasion, or laser treatments. These types of treatments treat the upper layer of skin and can remove skin irregularities. When these are completed by a dermatologist, they can be effective in reducing the appearance of melasma.
No treatment works immediately. According to American Academy of Dermatologists, it can take several months of treatment to see improvement. When your treatment is ended, your doctor might recommend that you continue to use topical treatments as a preventive measure. The good news is that both the intensity of the dark patches and the prevalence tend to fade with age.
Before undergoing any treatment, check with your insurance company. Because there are no negative physical symptoms, such as pain, and melasma is considered a benign skin condition, your insurance company might consider treatment to be cosmetic in nature and decline coverage.
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Eileen Bailey is a freelance health writer. She is the author of Idiot's Guide to Adult ADHD, Idiot's Guide to Cognitive Behavioral Therapy, Essential Guide to Overcoming Obsessive Love and Essential Guide to Asperger's Syndrome. She can be found on Twitter @eileenmbailey and on Facebook at eileenmbailey.