Melasma is a hyperpigmentation (dark skin discoloration) disorder that is characterized with dark brown symmetric patches on the surface of the skin, primarily affecting the face. Melanin is a brown pigment produced by melanocytes, the pigment producing cells of our skin. Based on racial and environmental differences, the melanin concentration differs from person to person although certain medical conditions, drugs and topical applications (creams, gels, ointments) can also change skin pigmentation.

Causes of Melasma

Hyperpigmentation is the increased melanin production causing a characteristic dark discoloration of the skin. The increased melanin (pigment) production is often an indication of hormone imbalances in the body and therefore melasma is commonly found in women who are pregnant or on hormone replacement therapy (HRT).

Pregnancy causes an over stimulation of melanocytes (pigment cells) resulting in pigmentation occurring on the nipples, lower abdomen and face areas. Exposure of light on the skin can further aggravate the condition. The pigmented patches usually disappear after the birth of the baby or the cessation of the hormone therapy but in some cases it may remain as a permanent blemish.

Treatment for Melasma

Treatment for melasma does not have a 100% success rate as the as pigmentation can fade into the normal skin tone giving the appearance of a ‘cure’. There are preventative measures and treatment that can aid in the management of melasma.

• Treatment with 2% to 4% hydroquinone in a cream base may decrease pigmentation but may aggravate or cause dermatitis of the skin.
• Topical 0.1% tretinoin sequentially used with hydroquinone will enhance the effect in the treatment of melasma.
• Hydroquinone is contra-indicated in individuals with liver or kidney conditions, open cuts and bruises and severely sun burn skin. Individuals who have allergies, sensitive skin or are on certain type of medication need to use hydroquinone with caution especially if the treatment is long term.
• Long term application of hydroquinone can cause local ochronosis and hydroquinone creams should only be prescribed by your dermatologist. A skin assessment will first be conducted before you dermatologist will decide upon the most appropriate course of treatment.
• For the maximum bleaching effect from the use of hydroquinone applications, avoid excessive sun exposure. Light and sun sensitivity of the skin may be noticed after starting a hydroquinone cream.
• A sunscreen with a sun protection factor (SPF) of 15 to 30 should be used to prevent the aggravation of melasma. Avoid daily use of sunscreen creams with an SPF greater than 30.
• Small patches of melasma can be camouflaged with cosmetic creams that do not wipe off (stay-fast formulation) although these should only be used when other treatment is not successful.
• The use of corticosteroid creams are another common approach to treating early stages of melasma. Hydrocortisone applications are never recommended as it causes thinning of the skin and the condition often returns worse that the original state once the hydrocortisone is discontinued.

The cosmetic industry is constantly marketing new and more effective treatments for melasma, often promoting products that have not undergone clinical trials. From whitening creams (skin bleaches) to ascorbic acid (vitamin C) applications and vitamin A creams, melasma should be treated by a professional rather than risking your skin with overpriced, over-the-counter products.