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Melasma refers to abnormally dark pigmentation on the face, especially in the region of the upper cheeks, the bridge of the nose, the forehead and the upper lip, where it usually appears in a symmetrical pattern. Melasma can also appear on the arms or other areas that are exposed to sunlight. It is also called chloasma and is usually a tan, muddy brown or dark gray color. This excess pigmentation can happen to anyone, but it most often occurs in women, as it seen most often as the result of hormonal changes that take place during pregnancy; in fact, half of all pregnant women experience these changes in pigmentation. It is sometimes called the mask of pregnancy. Melasma can also be caused by birth control pills, which mimic pregnancy by the ingestion of hormones, or hormone-replacement therapy.


Melasma is produced when melanocytes, the cells which produce skin pigmentation, are stimulated by ultraviolet rays or by the female hormones estrogen and progesterone. These hormones cause the melanocytes to produce even more melanin pigments when the skin is exposed to the sun. People of Native American ancestry are particularly at risk, as are other people with a light-brown skin tone who live in regions with a great deal of exposure to the sun, such as the tropics. Another risk factor is heredity; if other people, especially women, in your family have melasma, or had the melasma mask while they were pregnant, your chances of developing melasma are greater.


Another risk factor for developing melasma is thyroid disease. In those with thyroid disease, a hormone called MSH, or melanocyte-stimulating hormone, produces more than it should. The result is that when you are under stress, you might experience an outbreak of melasma. Sometimes melasma can be the result of an allergic reaction to certain drugs; tetracycline and anti-malarial drugs are chief among these. It can also be a reaction to certain cosmetics. For example, when it is seen in men, it is usually as a result of using after-shave lotions, scented soaps, and other personal care items that have scents or additives.


A dermatologist can usually diagnose melasma simply by examining the tan or brown spots. They might also use a Wood’s Lamp. This is a tool used by dermatologists to shine ultraviolet light onto the patient’s skin. Under the ultraviolet light, different skin conditions will appear different colors; the dermatologist can use it to determine whether melasma is on the surface of the skin or buried deeper, and then can discern whether it is simply excess pigmentation or if it is a more serious threat.
Image: Melasma


Sunscreens should be used to prevent melasma or any other change in pigmentation that is caused by the sun. Dermatologists recommend a sunscreen of SPF 30 or higher, whether you go outside very much or not. This is especially important if you are pregnant or if you already have melasma spots on your face, since they can get darker if you expose them to sunlight.

If melasma is not prevented by the avoidance of sunlight, it can sometimes be treated with bleaching creams or other prescription creams, including steroid creams. However, it often disappears on its own, fading away after several months after childbirth or when you stop taking oral contraceptives or hormone replacement therapy. It can also be treated with tretinoin, an acid that promotes and increases skin cell replacement. Azelaic acid can also treat melasma by reducing the production levels of melanocytes. A dermatologist can give you a facial chemical skin peel, using certain chemicals that will cause the melasma to be removed with the rest of the skin. In some severe cases, laser treatment is effective, but this should only be done when it is appropriate, because in some cases laser treatment can make the melasma worse. Over the counter treatments such as skin peels and bleaches have very poor results and sometimes can make the condition even worse. If you wish to have your melasma treated, it is always best to see a dermatologist for medically safe treatment options.


Melasma does not cause any medical harm to the patient, and is not connected to any medical disorder. It is a harmless condition and fades in time of its own accord, but many people are distressed by the presence of new and perhaps unsightly marks on their faces and other places on their bodies. It is only in rare cases that a dermatologist has to take a biopsy to determine whether that melasma is something more serious such as skin cancer. The best and most effective treatment for melasma is cosmetic; you can cover your spots with a foundation and it will be difficult, if not impossible, to see. Dermatologists stress, however, that you must apply sunscreen before going out at all, or the melasma will get darker, and become more and more difficult to camouflage.

Though melasma is not harmful and does not strictly require treatment, it is very important that you get a diagnosis of melasma from your doctor or dermatologist. This is because there are other skin disorders that are more serious, that can also be identified by dark spots on the skin. Other illnesses that produce dark spots on the skin include fungal infections, such as tinea versicolor and vetiligo. These conditions both cause discolored patches of skin that an untrained eye might confused for melasma. Skin cancers, as well, can be indicated by discolored areas of skin, and unlike melasma, must be dealt with immediately.
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