Melasma is a chronic skin disorder that results in symmetrical, brownish
patches on the face, mainly affecting the cheeks, nose, forehead and upper
It is a very common condition affecting the middle aged people. It usually occurs between the age of 20 and 40 years. Melasma is more common in females than males.
It can lead to considerable embarrassment and distress.
The cause of melasma is complex.
There is evidence of strong genetic predisposition to melasma. One in every three people report a positive family history.
Melasma commonly arises in healthy adults. Chronic sun exposure causes increased deposition of melanin within the dermis, which persists long-term. Exposure to ultraviolet radiation (UVR) worsens the pigmentation because it activates the melanocytes to produce more melanin.
The various factors triggering melasma include:
Sun exposure and sun damage
Hormone treatments — oral contraceptive pills containing oestrogen and progesterone, hormone replacement, intrauterine devices and implants
Certain medications, scented soaps and cosmetics may cause a phototoxic reaction that can precipitate melasma
Melasma presents as irregular, light to dark brown coloured patches present
on both sides of the face.
The most common area to be affected includes the malar area (cheeks), followed by the nose, forehead and upper lip.
It might be also associated with prominent vessels in the background.
Melasma is usually very slow to respond to treatment, especially if it has been
present since a long duration.
Generally a combination of various treatment modalities is required to get the best results.
The therapeutic options include:
Melasma is a very difficult to treat condition. Single therapy is rarely helpful in
getting rid of melasma.
A combination of different therapeutic options including topical depigmenting agents, with oral tranexamic acid and anti-oxidants with a series of chemical peels and micro-needling have given great results in my clinical practice.
Fractional and Q-switched lasers are the most commonly used lasers in the
management of melasma. But, laser treatment is associated with lots of heat
generation in the skin manifesting as redness, which increases the risk of
post-inflammatory hyperpigmentation. This can make your melasma patch
Hence, lasers are usually not the first choice of treatment for melasma in coloured skin people.
On the contrary, the other physical modalities like chemical peeling, micro needling, face PRP and even photo facial, are safe as well as very effective in improving the pigmentation of melasma.
Sunscreen plays a very vital role in melasma management. As we all know that UV exposure precipitates as well as exacerbates melasma, so you can understand the importance of using sunscreen in this case.
It is advisable to use a broad spectrum sunscreen, preferably a sun block that
gives protection against UVA, UVB, as well as visible rays. The SPF should
be at least 30+.
Recently, there are many studies indicating the role of infrared (IR) rays in worsening of melasma pigmentation, so one should use a sunscreen which also has some anti-oxidants like vitamin A, and E, to get that additional protection against IR rays.
Mere usage of sunscreen is not enough!
To avail maximum benefits of a sunscreen, you should know how to use it.
Following are the correct methods of using a sunscreen:
Results take time, and the above measures are rarely entirely successful.
The chances of recurrence is present if proper sun protection is not taken, or if there occurs any hormonal imbalances. Continuous research is going on to discover newer topical and oral agents for effective treatment in the future.
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