Melasma (Chloasma): Causes, Symptoms & Treatments

If you experience melasma, it can be a worrying and unsightly experience. But for those at higher risk of this health condition, it is important to understand what causes it, ways of treating it and associated potential risks.

What is Melasma (Chloasma)?

Melasma is a skin condition in which certain areas of the skin become darker than the surrounding skin. It mainly occurs on the face, in regions like the cheekbones, forehead, upper lip, and chin. The skin color change can be brown, tan or a blue-gray, and can occur rapidly. Also known as chloasma or “mask of pregnancy”, this condition often affects women who are in their child-bearing years but is particularly common in women who are pregnant. The main causes of this are hormonal changes, sun exposure, and genetic predisposition, so the appearance of melasma can be a sign that you are at higher risk of developing skin cancer (due to sun exposure).

Melasma in Men

It is possible for men to suffer from melasma but the condition primarily affects women. Roughly 90% of all cases of melasma are women, due to the higher sensitivity to hormonal changes in women, and so this condition is usually considered as belonging to that gender. However, for men who work outside in the sun for long period of time, this condition is also occasionally seen. The treatment is much the same for either gender and tends to involve spending less time in the sun.

Types of Melasma

There are three main types of melasma – epidermal, dermal, and mixed melasma.

Epidermal – This type affects only the epidermis, which is the outermost layer of skin cells.

Dermal – This type affects the dermis, which is the slightly lower, secondary layers of skin cells.

Mixed – This type includes melasma on both the dermal and epidermal layers of your skin.

Causes of Melasma

As mentioned, the causes of melasma are varied and compounding, so it can be difficult to pinpoint the precise cause of this condition. The main causes are as follows:

Stress: Any fluctuation in stress levels can have an impact on your hormonal levels, which can trigger a period of melasma on your face.

Thyroid Disease: When your body is unable to properly create or regulate your hormone levels, this skin affliction may appear as a result.

Sun Exposure: When solar radiation penetrates the skin cells, it can affect the pigment-creating cells of the body, leading to darker patches of color.

Genetic Predisposition: Some evidence has been found that melasma is genetically linked, but this area still requires more research, and the condition is not widely considered hereditary.

Hormonal Fluctuations: The reason that a “mask of pregnancy” is seen so often in pregnant women is that hormonal fluctuations can spark a flare-up of this condition. This could also be the result of steroid use, certain medications, or changing birth control.

Is Melasma Hereditary?

Melasma is not specifically considered hereditary but there is an admitted genetic connection. Since an excess of melanocytes is known as a triggering cause of this condition, mutations in the genetic code that lead to higher melanocyte levels could also increase your risk of developing melasma at some point in your life.

Symptoms

The main symptoms of melasma include dark patches of skin on the face, including the bridge of the nose, cheekbones, forehead, chin, and upper lip. While it is possible to develop these patches on the neck or forearms – other areas that are exposed to a lot of sunlight – this is far less common. These patches of discolored skin are the only symptoms of this superficial condition.

Diagnosis

This condition is diagnosed quite easily and is normally done with a visual exam. In some cases, where there may be another explanation for the symptoms, a biopsy may be taken. There are certainly specialized lamps that can illuminate different layers of skin and can help doctors identify any possible infections in the affected areas.

Risk Factors

The risk factors for this skin condition are closely tied to the potential causes, in addition to your original skin color. Darker-skinned people tend to be more susceptible, including African, Asian, Mediterranean, and Middle Eastern individuals, as well as Pacific Islanders and Central Americans. This may have to do with these people having a higher level of melanocytes in their skin, to begin with.

Other risk factors for chloasma include fluctuating hormone levels, particularly high levels of progesterone and estrogen. When these hormones are affected by birth control pills, certain medications or pregnancy, it can quickly lead to the appearance of these dark patches.

Excessive exposure to sunlight will also increase your risk of developing this condition since the ultraviolet light can have an effect on pigment cell production.

Treatments

There are a few ways that can help to remedy this potentially embarrassing skin condition, including skin-lightening creams, cosmetic procedures or topical steroids. However, in many cases, chloasma will fade on its own, typically when the pregnancy has ended or your hormones have a chance to rebalance naturally. For some people, melasma will return at other times in their life, making the avoidance of direct skin exposure often the best treatment/preventative measure.

Cosmetic Procedures

Chemical peels or dermabrasion have been known to be quite effective in lessening the appearance of these patches of skin. This is particularly effective for epidermal melasma, as it only affects the top layers of skin, which are often removed through these procedures.

Skin-Lightening Creams

Certain creams are able to lighten the skin, allowing you to blend the darker regions of your skin into the surrounding areas. These creams aren’t effective for dermal melasma, but can often help lessen how obvious the condition appears.

Topical Steroids

Certain types of topical steroids can be directly applied to the discolored areas to stimulate proper balance of skin pigment cells. This is not always successful, but it is a relatively non-invasive and simple remedy for some people.

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