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Melasma

Definition

Melasma is a skin condition where brown patches appear on the skin. These patches usually appear on the cheeks, nose, forehead, chin, and upper lip. Patches can also appear on the neck and forearms.

Because it is common in pregnant women, melasma may be referred to as the mask of pregnancy.

Common Sites on the Face for Melasma
AM00013 face
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Causes

The brown patches are due to an increased amount of melanin in the skin. The exact cause of increase in melanin is unknown. It is thought to be associated with hormones such as estrogen and progesterone. Sun exposure also plays a major role.

Risk Factors

Melasma is more common in women during their reproductive years, but it can occur in men. Other factors that increase may your chance of melasma include:

  • Family history of melasma
  • Being a woman of reproductive age
  • Having a darker skin tone
  • Pregnancy
  • Getting too much sun exposure
  • Taking birth control pills
  • Using products that irritate the skin, such as cosmetics
  • Certain medications, such as antiseizure drugs or hormone therapy

Symptoms

The only sign of melasma is dark patches of skin. It is not painful or itchy.

Not all brown patches on your skin are melasma. Talk to your doctor about changes in your skin.

Diagnosis

Your doctor will ask about your symptoms and medical history. Your skin will be examined. A lamp, called a Wood’s lamp, may be used to look at your skin. A small sample of skin may be taken for a biopsy. The sample will be sent to a lab to confirm the diagnosis.

Treatment

Melasma may go away on its own. If it does not go away, it may need to be treated. In general, treating melasma can be difficult. Talk with your doctor about the best treatment plan for you.

Removing Cause

Factors that are causing the melasma may be removed. For example:

  • Melasma associated with pregnancy may slowly fade after giving birth
  • Melasma associated with birth control pills or hormone replacement therapy may fade after the medication is stopped

It can reappear and become darker if you become pregnant again or resume taking medication.

Avoid using products that can irritate your skin. These include make-up, creams, and cleansers.

Ultraviolet Light Protection

Protecting your skin from UV light is important in helping to fade melasma. This means avoiding sun and tanning bed exposure. Your doctor may recommend wearing sunscreen, clothing, and hats when outdoors.

Depigmenting Medications

Certain medications, like bleaching creams, are used to lighten skin color. A common bleaching cream used to treat melasma is hydroquinone. This may also be used with other creams or combination of creams such as tretinoin, corticosteroids, azelaic acid or glycolic acid. These creams enhance the skin-lightening effect.

Your skin may be sensitive to these medications. Use care and start slowly when first using them. It may take several months before you see an improvement.

Other Treatments

Other treatments remove outer layers of the skin. These include:

  • Chemical peel
  • Microdermabrasion—removing top layer of skin
  • Laser therapy

Prevention

To help reduce your chance of getting melasma:

  • Limit the amount of time you spend in the sun. Avoid using tanning booths.
  • Use sunscreen daily. Wear sunscreen that protects against both UVA and UVB rays and has an SPF of 30 or more.

Revision Information

  • American Academy of Dermatology

    http://www.aad.org

  • FamilyDoctor.org - American Academy of Family Physicians

    http://familydoctor.org

  • Canadian Dermatology Association

    http://www.dermatology.ca

  • Public Health Agency of Canada

    http://www.phac-aspc.gc.ca

  • Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol. 2006;55(6):1048-1065.

  • Melasma. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/m---p/melasma. Accessed May 22, 2014.

  • Melasma. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/?page=Melasma. Accessed May 22, 2014.

  • Melasma. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/melasma.html. Updated February 2011. Accessed May 22, 2014.

  • Prignano F, Ortonne JP, Buggiani G, Lotti T. Therapeutical approaches in melasma. Dermatol Clin. 2007;25(3):337-342.

  • Tierney EP, Hanke CW. Review of the literature: Treatment of dyspigmentation with fractionated resurfacing. Dermatol Surg. 2010 Oct;36(10):1499-508.

  • Treatments of discomforts during pregnancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 2, 2013. Accessed May 22, 2014.

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