What is melasma, and what causes it?

Melasma is a chronic skin condition characterised by symmetrical, irregular brown patches on the face. It is most commonly seen on the cheeks, forehead, bridge of the nose, upper lip, and chin. This is due to the over production of melanin (a pigment that gives dark color to the skin) by the melanocyte cells. It is usually triggered by ultraviolet radiation, hormonal changes (especially during pregnancy), genetic predisposition, and cutaneous inflammation. 

Who is most likely to develop melasma?

Melasma mainly affects women.I n India, studies report a prevalence of 20–30% among dermatology outpatients, especially in women aged 20–50. People with dark skin tone, pregnant women and women who are on hormonal therapy are more prone to it.

Can melasma be cured permanently?

Melasma doesn't get cured permanently but the treatment can fade, control and prevent the recurrences of it. Even with good treatment, it can always come back.

What are the treatment options for melasma?

Melasma treatment involves a combination of topical agents, procedures, and sun protection. 

  • Topical Agents: This is the first line of treatment. Usually a combination of azelaic acid, kojic acid, and newer agents like topical tranexamic acid. These help reduce melanogenesis and pigmentation.
  • Procedures: Dermatologists use chemical peels, microdermabrasion, and low-fluency laser therapy for stubborn or relapsing melasma but require caution in darker Indian skin types to avoid post-inflammatory hyperpigmentation.
  • Photoprotection: Daily use of broad spectrum sunscreen with SPF ≥30.

How can melasma be prevented or controlled long-term?

Melasma can be prevented by a multifactorial approach. Avoid direct sunlight; use hats and sunscreen daily. Always take hormone-triggering agents like OCPs with caution and only under medical supervision. Use maintenance depigmenting creams as advised by the doctor. Early treatment improves prognosis and reduces dermal involvement.

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