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Melasma is a type of hyperpigmentation or darkening of the skin that is seen commonly in persons with tan or darker skin tones. It is often present on the forehead and at the cheekbones.
Melasma, also known as the “mask of pregnancy”, most often affects women, and results from sun exposure, but can be seen in the non-pregnant state and can also occur in men. It is reported that 10% of cases occur in men. The cause of this disorder is unknown, but it is thought to be linked to female hormones, pregnancy, oral contraceptives, or medications. The pigment usually develops rapidly over a few weeks, occurs on sun exposed areas of the body such as the forearms, but most commonly occurs on one’s face. While hyperpigmentation may improve on its own, it may re appear with introduction of triggers such as pregnancy, medications, acne, psoriasis, hormone replacement therapy etc. The pattern of hyperpigmentation is patchy, irregular in shape, and can be pink, brown or greyish brown or deep brown in color. Increased melanin pigment, the pigment that allows us to tan, can be found within the epidermal or upper segment of skin or in the dermis which lies below the epidermis. This penetration of pigment is what will determine how effective if any the topical DE pigmenting agents, laser and peels will be. If the pigment is predominantly epidermal, therapy should be successful. If the pigment lies mostly in the dermis, then this condition is similar to a tattoo and treatment will be less successful.
Your Dermatologist can diagnose hyperpigmentation from Melasma clinically. Various treatment options for Melasma include hydroquinone, the gold standard, between 2-4%. Azelaic acid, and Kojic acid can be beneficial. Topical retinoids, steroids and alpha hydroxy acids can be added to improve efficacy of the hydroquinone product. Hydroquinone, combined with a topical steroid and retinoid, known as the “Kligman formula”, since its development by Dr. Kligman, is commercially known as Triluma, has been found to be helpful. It is important to avoid using higher percentages of hydroquinone, since this can produce an irritant dermatitis and further hyperpigmentation.
Treatment can last between 2-12 months. It is important to have patients use an opaque high SPF sunblock daily to prevent further darkening of the skin. It is helpful to avoid sun exposure between 10am and 4pm. Ultraviolet light exposure can occur through a car window or from office lighting hence reactivating hyperpigmentation. Reapplication of sunblock should occur every two hours while outdoors or after excess sweating or if swimming. The use of photo protective clothing such as visors, tops and hats with a UPF 50 designation indicates there is an adequate amount of protection in the clothing. Wearing white or bright color clothing or tight woven cotton fabrics offer photo protection. Present day treatments can eliminate pigmentation in the epidermis only such as peels, laser, or hydroquinone. Treatments that can penetrate below the epidermis, such as medium or deep peels, run the risk of producing irritation, scarring and should be avoided.
Treatment should be geared to gently eliminate or decrease the hyperpigmentation, so that corrective makeup if necessary can be used to cover any imperfections. Your Dermatologist can guide you in finding the correct treatment choice for you.