Melasma

Melasma sometimes know as the "Mask of Pregnancy" is a common skin disorder seen in women. Sometimes referred to as cholasma, the condition is frequently seen in pregnant females and often referred to as the “mask of pregnancy”. It presents as a dark facial skin rash with irregular borders.

The rash is usually recognized by its symmetrical presentation on the cheeks, lips, nose or the forehead. Rarely the skin discoloration can also occur on both the upper arms.

Melasma can vary in color ranging from a dark brown to a deep grey.

The condition is universal and seen in women of all cultures and ethnicities. However, it is far more common in Asians, Hispanics, Arabs and North African women. Individuals with fair skin usually have a very lighter shade of Melasma which is not always recognized.

Even though Melasma is most common in pregnant females, it can occur in non pregnant females. The condition is predominantly seen in females, but it does occur in males sometimes. The condition is most common in the 2nd and 3rd decade of life.

Causes of Melasma

The cause of Melasma remains unknown but is believed to be due to an increase in the production of cells which release the pigment, melanin. It is melanin which is responsible for the dark color of the skin.

What causes the increased production of melanin is not known but some triggers include:

• HeredityHormones, the rash is most common in pregnant females
• Prolonged sun exposure
• Use of the birth control pill
• Certain medications like the tetracycline, anti malarial drugs

Melasma is not related to any medical disorder and by itself is a harmless skin condition. In the majority of cases, the diagnosis of Melasma during pregnancy is relatively easily made by a dermatologist. In the non pregnant individual, drugs and other medical conditions may have to be ruled out. Nevertheless, it is the very rare case that requires a skin biopsy for diagnosis.

The most important fact to understand about Melasma is that in the majority of cases it is a transient skin disorder. When Melasma occurs during pregnancy, it generally resolves after delivery. In cases where the Melasma occurs in non pregnant women, it may exist for a few months to a few years and then suddenly resolve. Thus treatment is not always warranted. It is difficult to know in which individuals the rash will remain and in whom it will disappear.

Further, the treatment of Melasma is primarily cosmetic since the skin disorder has no medical consequences.

Melasma Treatment

Over the years, the various treatments developed to treat Melasma include:

• Chemical peels. There are a few chemical peeling acids that have been used to treat Melasma. The most common include trichloroacetic acid, azelaic acid, glycolic acid, lactic acid and various fruit extracts. The effectiveness of many of the lighter strength peeling agents is poor. The stronger peeling agents do work but they also carry the risk of side effects such as burning, skin peeling, scarring and even worsening the skin discoloration
• Bleaching agents. There are a variety of bleaching agents and the most common one used is hydroquinone. There are numerous other agents sold in herbal and nutrition stores that have been touted to work as bleaching agents, but their safety is in question.
• Sunscreens
• Laser rejuvenation

None of these treatments can cure Melasma and they do not always work either. Less than 50% of individuals show any response. Even in those who respond, the skin discoloration is not always completely erased. The treatments have to be continued for an indefinite time because the pigmentation can get worse with time.

Since there is no perfect treatment, one can prevent it from getting worse. Wearing sunscreens is essential in preventing the worsening of Melasma.

One should wear a sunscreen which contains both inorganic and organic compounds and has a SPF of > 20. Protective clothing and wearing a hat are all essential in preventing worsening of this skin disorder.

The most important thing about Melasma is that it is a completely benign medical disorder with no untoward health consequences. The treatment for Melasma is only for cosmetic reasons. The majority of treatments are not only expensive, but are not curative and there is no guarantee that they will work. Infact, some treatments can even worsen the skin condition.

The best and safest treatment is camouflage of the skin disorder and wearing a sunscreen to prevent the condition from getting worse. In the end one should always question a treatment of a condition which can spontaneously resolve by itself?