MELASMA
Melasma is a skin condition where there is a darkening in sun exposed areas. The cheeks, upper lip, chin, and forehead are the areas most commonly affected, but it can occur in any sun-exposed area. The discoloration is usually symmetrical. The discoloration may present as spots or one large area.
Chloasma is a term used to describe melasma that may occur during pregnancy. This condition has been called “The mask of pregnancy.” Melasma is much more common in women than in men and it is much more common in darker skin types such as Hispanics and Asians. Persons of any race can be affected, however.
The exact cause of melasma is not known. Melasma often occurs during
pregnancy and with the use of oral contraceptive pills so there is some relationship with female hormonal activity. The most important factor in the development of melasma is exposure to sunlight. Without the strict avoidance of sunlight successful treatment of melasma is doomed to failure.
Melasma can be very difficult to treat particularly if strict avoidance of sunlight is not heeded. Laser therapy at this time is not the standard of care for treating this condition. While there is evidence that lasers are helpful in some patients, results are unpredictable with potential adverse side effects. In any case patch testing should be performed prior to attempting treatment with this modality.
Patients with melasma should be managed by physicians trained and qualified in treating this condition. The mainstay of treatment remains topical de-pigmenting agents such as Hydroquinone, Tretinoin or Azelaic acid. Cryotherapy and chemical peels along with laser therapy have been beneficial in some patients. The resolution of the condition is slow and sun avoidance is essential.