Melasma

What is Melasma?

Melasma (also known as chloasma) is a common non-contagious skin disorder, causing irregular brown patches primarily on the face. It is most common in women, especially during pregnancy, in people of colour, and those who suntan easily. Melasma is benign, has no morbidity, and does not lead to cancer such as melanoma. However, it can have a psychosocial impact on those affected. The condition usually disappears in a few months in people who do not seek treatment and avoid the sun.

Can I obtain treatment online?

The Online Clinic can prescribe treatments for Melasma online following a free consultation with a doctor. Please click on the button below to proceed.

Who gets Melasma?

Melasma occurs worldwide at a prevalence of 1.5%-33% depending on the country’s regional population. It is more common in people with darker than lighter skin colour, and it is especially common in those with light brown skin. The condition generally affects females, and is nine times more common in women than in men. Melasma usually starts between 20-40 years of age, is rare before puberty, and occurs in up to half of women during pregnancy.

What causes Melasma?

Melasma is caused by the pigment-producing cells in the skin - called melanocytes - being stimulated to produce too much of the pigment melanin (referred to as hyperpigmentation).

The most important factor in the development of melasma is exposure to sunlight. The sun’s ultraviolet (UV) radiation stimulates the production of melanocyte–stimulating hormone and other natural chemicals, which leads to melanocytes producing more melanin. Continuous UV exposure then leads to skin inflammation that also results in melanin production. Additionally, melanocytes are stimulated by the female sex hormones oestrogen and progesterone to produce more melanin pigments when the skin is exposed to the sun.

Factors that can contribute to melasma and excess melanin production include genetic influences, UV radiation (from the sun and sunbeds), hormones, pregnancy, medications (e.g., hormonal therapies, antiseizure medications, and phototoxic drugs), thyroid problems, and cosmetics.

Who is at risk of Melasma?

Factors that increase the risk of melasma include:

• Family history of the condition
• People with skin of light-brown colour
• Women
• High exposure to sun light
• Pregnancy
• Increased hormone levels, such as oestrogen, progesterone, and melanocyte-stimulating hormone
• Medicines such as combined hormonal oral contraceptives and hormone replacement therapies
• Thyroid disease

What are the signs and symptoms of Melasma?

Melasma generally occurs on exposed areas of skin. Melasma is characterised by light-to-dark brown areas of skin that appears on both sides of the face. It may develop as small freckle-like spots or irregular-shaped patches that join together. The cheeks, forehead, upper lip, and chin are typically affected, although melasma can develop on other exposed areas such as the jawline, neck or arms. Melasma has no physical symptoms and is neither painful nor itchy, but its appearance may be upsetting. Melasma becomes more visible when skin is exposed to the sun.

How is Melasma diagnosed?

Diagnosis of melasma can be made based on its appearance. To aid diagnosis in a face to face environment, a Wood’s lamp that emits black light and dermoscopy using polarised light show pigmentation and other skin differences between the affected and normal skin. In some cases, thyroid function tests may be helpful.

Many skin conditions, including freckles, actinic lichen planus, and discoid lupus erythematosus, have similar features to those of melasma. A skin biopsy may be necessary to rule out such other conditions.

How is Melasma treated?

In most cases, melasma resolves in a few months without treatment, particularly when it is caused by a trigger such as pregnancy (resolves when the baby is delivered) or a medicine (when the medicine is stopped).

Avoiding the sun and protecting the skin from sunlight are essential as the skin affected by melasma will become darker than the unaffected skin, making melasma more visible. Wearing a wide-brimmed sunhat, using a high-factor/broad spectrum sunscreen, keeping in the shade, and avoiding sun bathing and tanning beds will protect the skin from UV radiation as well as make melasma medications more effective. Skin camouflage, a coloured cream that is matched to your skin colour, can be used to cover melasma.

Medicines used for melasma are those that stop melanin production and reduce the excess melanin in your skin. Medicines are usually those applied to the skin. They can be products containing one active agent or combinations with two or three active ingredients. Hydroquinone is commonly used for melasma as it prevents melanin production and evens out skin tone. A dual combination product containing tretinoin (a retinoid) and a mild corticosteroid (an anti-inflammatory such as hydrocortisone) also evens out skin tone. The triple combination cream containing tretinoin, a corticosteroid, and hydroquinone (Pigmanorm) works in three ways by reducing pigmentation, reducing inflammation, and evening skin tone, respectively. Other medications including azelaic acid, kojic acid, and ascorbic acid may be less irritant on the skin. If melasma does not respond to any of these medicines, topical or oral transexamic acid may be used as it can reduce melasma patches that are resistant to other treatments. At The Online Clinic, we offer Pigmanorm, Azelaic Acid 20% (Skinoren) or Tretinoin 0.1% topical application as treatments for Melasma.

When these medicines do not improve melasma, chemical peels, microneedling, laser and light treatments, and platelet-rich plasma can be used to even skin tone, remove excess pigment, or affect the pigment-producing cells. These techniques should be performed by qualified practitioners because they all can make the skin worse.

References

Basit H, Godse KV, Al Aboud AM. Melasma. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459271/

American Academy of Dermatology Association. Melasma.
Available from: https://www.aad.org/public/diseases/a-z/melasma-overview

British Skin Foundation. Melasma.
Available from: https://knowyourskin.britishskinfoundation.org.uk/condition/melasma/

Doolan BJ, Gupta M. Melasma. Aust J Gen Pract. 2021;50(12):880-885. doi: 10.31128/AJGP-05-21-6002. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014 Sep-Oct;89(5):771-82. doi: 10.1590/abd1806-4841.20143063. Rajanala S, Maymone MBC, Vashi NA. Melasma pathogenesis: a review of the latest research, pathological findings, and investigational therapies. Dermatol Online J. 2019;25(10):13030/qt47b7r28c.