Melasma or Mask of Pregnancy

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The spots usually show up on the person's cheeks and forehead and are due to an increase in pigmentation. When a woman becomes pregnant, their body produces more hormones, causing an increase in the pigmentation of her skin. Approximately fifty-percent of women who become pregnant display signs of melasma. There are some men who experience melasma as well.

Melasma is believed to be largely related to sun exposure, hormones such as birth control pills, as well as internal hormonal changes due to pregnancy. The majority of people with melasma have histories of regular exposure to the sun. Melasma is more common in pregnant women of Asian and Latin descent. People who have olive or darker skin have higher rates of the skin condition. There are an estimated six-million women in America with melasma; greater than ninety-percent of all people with the skin condition are women.

Causes of Melasma

Medical science is unsure of the exact cause or causes of melasma, although it is believed that the skin condition might be caused by various factors such as:

• Pregnancy
• Birth Control Pills
• Exposure to UV Light
• Anti-Seizure Medications
• Family History of Melasma
• Other Forms of Medications
• Hormone Replacement Therapy

Excessive exposure to sunlight is believed to be the leading cause of melasma, particularly in people who have a genetic predisposition to the skin condition. Studies have demonstrated that people commonly develop the condition during the summer while the sun is most intense. During the winter months their hyper-pigmentation is often lighter, or less visible.

Another term used to describe melasma is, 'chloasma.' Women who are pregnant have an increase in progesterone, estrogen, and melanocyte-stimulating hormone levels while in the second and third trimesters. It is thought that pregnancy-related melasma is due to an increase in the levels of progesterone and not melanocyte-stimulating or estrogen hormones. Studies have also demonstrated that women who are postmenopausal who receive progesterone hormone replacement therapy have an increased risk of developing melasma. Postmenopausal women who receive estrogen only appear less likely to develop the skin disorder. The potential for treatments or products that irritate a person's skin to cause an increase in melanin production and potentially accelerate melasma symptoms also exists.

Types of Melasma

There are four types of pigmentation patterns that are diagnosed in melasma:

• Mixed
• Dermal
• Unnamed
• Epidermal

Dermal melasma is determined by the presence of melanophages, or cells that ingest melanin, through the persons dermis. The epidermal form is determined by the presence of excess melanin in the person's superficial layers in their skin, while the mixed type includes both the dermal and epidermal forms of the skin disorder. The unnamed type finds excess melanocytes present in the skin of people who are dark-complexioned.

Diagnosing Melasma

The appearance of brown patches of skin on a person's face makes melasma readily diagnosable. A dermatologist is a physician who specializes in skin disorders. A dermatologist can many times diagnose melasma through a visual examination of the person's skin. Use of a, 'Wood's light,' or black light can help them to diagnose melasma as well. In the majority of cases a diagnosis of mixed melasma is diagnosed, meaning the discoloration of the person's skin is due to pigmentation in their epidermis and dermis. On rare occasion, a skin biopsy might be required in order to assist a dermatologist in excluding other causes.

Treatment of Melasma

The more common treatments for melasma involve application of creams that include two-percent hydroquinone such as Porcelana and Esoterica, or prescription four-percent creams like Glyquin, Tri-Luma, Obagi Clear, or Solaquin. Studies have demonstrated that creams containing two-percent hydroquinone can be highly-effective at lightening a person's skin and are less irritating than creams with higher concentrations of hydroquinone. The creams are meant to be applied to the brown patches on a person's skin two times per day. Sunscreen should also be applied over the hydroquinone cream each morning. There are various forms of treatments for melasma, although the epidermal type of the skin condition responds better to treatment than other types because the pigmentation is closer to the person's skin surface.

Melasma may also disappear spontaneously without any form of treatment. At other times, the condition might clear up with the application of sunscreen and avoidance of sunlight. Others find that melasma disappears after pregnancy, or if their birth control pills and hormone therapy are discontinued. To treat melasma, combination or specifically formulated creams containing hydroquinone, azelaic acid, a phenolic hypo-pigmenting agent, and retinoic acid, non-phenolic bleaching agents, and/or kojic acid might be prescribed by a doctor. For people who experience severe melasma, creams containing a higher concentration of hydroquinone or creams that combine hydroquinone with additional ingredients like corticosteroids, tretinoin, or glycolic acid might help to lighten their skin.

Potential side-effects of melasma treatments include temporary skin irritation. People who us creams with high concentrations of hydroquinone over lengthy periods of time, commonly periods of months to years, have a risk of developing a side-effect referred to as, 'ochronosis,' a permanent skin discoloration. While ochronosis is common in America it even more common in places such as Africa where hydroquinone creams containing concentrations of ten-to-twenty percent can be used to treat melasma. Despite the possible side-effects, hydroquinone is still the most commonly-used and successful cream for treatment of melasma around the world. It is important for people with melasma who use hydroquinone creams to pursue regular follow-up appointments with their doctor, as well as to continue using hydroquinone creams at the first signs of ochronosis.

Along with hydroquinone creams, treatments in a doctor's office can include microdermabrasion, chemical peels, and laser therapy. The treatments can be useful for people who have more severe cases of melasma. There are different types and strengths of chemical peels for people with various skin types. The type of peel is tailored for each person and is selected by their doctor.

Treatment with thirty-to-seventy percent glycolic acid peels are common. Different combinations, to include a mixture of ten-percent glycolic acid and two-percent hydroquinone, may be used as well.

Microdermabrasion uses an abrasive material and vacuum suction to exfoliate the top layers of the person's skin. The vacuum pressure is something the person's doctor adjusts depending on the sensitivity and tolerance of the person's skin. A common microdermabrasion treatment might last from a few minutes to an hour. Recovery time is minimal or non-existent. The techniques may improve the skin condition, although noticeable results are often not visible or expected within the first couple of treatments. A number of treatments along with creams and sunscreen produce the best results.

There is also no guarantee that the melasma a person experiences will improve with microdermabrasion. If the treatments are too abrasive or harsh, the melasma could actually worsen, or be further induced. In addition, the procedures are nearly always considered to be cosmetic ones that might not be covered by the person's medical insurance.

Laser Treatment and Melasma

While lasers can be used to treat melasma, laser therapy is not the main choice to treat the skin condition because studies have shown there is little or no improvement in the hyper-pigmentation in most people affected by melasma. Lasers can even temporarily worsen some types of the skin condition and need to be pursued with caution. A number of laser treatments might be needed in order to see any results; treatments are most effective when they are repeated.

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