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Call-On-Doc Focus: What Is Melasma?

Published on May 15, 2023 | 10:02 AM

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Both men and women are affected by melasma, a common skin disorder. However, the vast majority of those who will develop the condition are women. Today we will cover what you need to know about melasma, including causes, triggers, and treatment and prevention strategies.

Melasma, Defined

Melasma is the scientific term for a medically harmless disorder that causes dark patches or spots of skin. The condition is also called chloasma or the “mask of pregnancy” when it occurs in a pregnant woman.

There are three types of melasma. Epidermal melasma affects the skin’s outer layer, or epidermis. Dermal melasma affects the skin’s middle layer, or dermis. Mixed melasma occurs in both the outer and middle layers of the skin.

Melasma Causes

Melasma is caused by overactive melanocytes, which are the skin cells responsible for producing pigment. Melanocytes become overactive when triggered. The condition has been linked to excess estrogen, which is the reason such a high percentage of cases occur in women.

Other common causes of melasma include:

  • Family history
  • Taking birth control pills
  • HRT (hormone replacement therapy)
  • Sunlight, tanning beds, and infrared light
  • Hypothyroidism or underactive thyroid
  • Drugs
  • Skincare products
  • Folic acid deficiency
  • Having sensitive skin
  • Hormonal fluctuations
  • Cosmetics that increase skin sensitivity to sunlight (phototoxic)
  • Pregnancy
  • High copper levels in the blood
  • Some cosmetic procedures
  • Having a darker skin type

Symptoms of Melasma

Melasma is characterized by flat spots or patches of skin that are dark brown, light brown, or bluish-gray in color. The patches may or may not become red in color or inflamed. Melasma occurs most commonly on:

  • All sides of the neck (in those 50 years and older)

  • Nose and cheeks (malar melasma)
  • Upper arms and shoulders (brachial melasma)
  • Jawline (mandibular melasma)
  • Both cheeks (lateral cheek pattern)
  • Upper lip, nose, cheeks, and forehead (centrofacial melasma)

Sunscreen and Melasma Prevention

Because sunlight is a common trigger for the development of melasma, sunscreen is a typical recommendation to prevent the condition. The best sunscreen to prevent melasma will be an SPF 30 mineral sunscreen with zinc oxide and homosalate as active ingredients, as this will moisturize and tint the skin instead of leaving a white cast.

In order to protect the skin from the damaging effects of UV rays, sunscreen should be applied 15 minutes before going outside. Tegular application, as well as reapplication every two hours while outside are recommended.

Concerns have been raised about sunscreen blocking the skin’s ability to create vitamin D from the sun’s UVB rays. A blood test can confirm whether or not your vitamin D is at optimal levels.

If chemical sunscreen is not preferred, wear a wide-brimmed hat and/or SPF 50 UV-protective clothing for sun protection or limit sun exposure.

Weather Factors and Their Impact on Melasma

UV rays both can worsen melasma and increase your risk of developing skin cancer. The intensity of UV rays is higher during the summer months when the sun is nearer to the earth. UV rays are also more intense in locations that are closer to the equator.

Hot weather can cause increased dilation in blood vessels, which can help to stimulate excess pigmentation. Those with melasma may find their condition worsens in the winter, when air contains far less moisture and heating removes it from the skin.

Cold and dry conditions can lead to irritation, which can trigger melasma. Staying hydrated and ensuring the skin is well-moisturized are two ways to prevent the condition.

Remember that UV rays are present whether it’s cloudy, raining, or sunny. To prevent skin cancer and the development or worsening of melasma, be sure to cover up with some manner of skin protection before heading out this Mother’s Day.

Additional Anti-Aging and Skin Care Strategies

Certain treatments can help to lessen the appearance of dark skin caused by melasma.

Topical Treatments

Hydroquinone is a product that can lighten skin. It’s available in emulsion, lotion, gel, or cream form.

Retinol is a popular anti-aging treatment that can also help melasma sufferers. Retinol increases the rate at which new skin cells are formed, which can help eliminate melasma spots more quickly.

Azelaic acid is a topical pharmaceutical used to treat rosacea that can also be effective for melasma. This product helps those with red and inflamed skin to reduce these symptoms. It also protects the skin from becoming infected.

Cosmetic Treatments

In-office treatments have been used successfully in the treatment of dark spots and patches associated with melasma.

Chemical peels remove the skin’s top layer and encourage the growth of new skin.
Microdermabrasion also removes the skin’s top layer and encourages new growth.
Laser therapy may offer a solution for those who have been unsuccessful with other melasma treatment methods. This option lightens dark spots and patches.

Lifestyle Modification

Stress can exacerbate any condition, including the appearance of melasma spots and patches. Reducing stress through exercise, meditation, yoga, and other similar ways can help.

Diet and nutrition have well-known effects on health. Optimizing the diet is crucial for patients with melasma. Replacing inflammatory processed foods with natural choices can reduce chronic inflammation. Foods that are high in antioxidants will help the skin to repair damage caused by UV rays.

Eating foods that are high in folate can correct deficiency that causes melasma. Balance the amount of copper in the diet by limiting intake to the following:

  • 900 mcg for non-pregnant adults
  • 1000 mcg for pregnant women
  • 1300 mcg for breastfeeding mothers

If blood copper levels are too high, it can be helpful to add foods or supplements that contain iron and vitamin C.

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Wayne C. Hahne,

English graduate and Call-On-Doc’s medical resource guide, Wayne C. Hahne is an experienced and passionate medical education content expert. Through diligent research, provider interviews and utilizing the industry's leading resources for wellness information, it is Mr. Hahne’s personal mission to educate the general public on medical conditions with in-depth and easy-to-understand written guides.

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