Melasma is a common skin disorder typically seen as light brown to dark brown or sometimes blue-gray freckle-like spots or flat patches on your skin. The literal meaning of the term melasma is ‘black spot’. 

Melasma is commonly seen in the sun-exposed parts of the skin such as face and forearm. Anyone can get melasma, but it is comparatively more common in women. It is very common during pregnancy and is therefore, sometimes called the ‘mask of pregnancy.’ Melasma is a harmless skin condition, nevertheless it may cause a significant psychological impact since it compromises the esthetics of your skin. 

In this health article let us explore the treatment options available for melasma.

To begin with, it is important to understand that melasma develops due to multiple factors, including but not restricted to photosensitivity (exposure to sunlight), hormonal imbalances, contraceptive measures, genetics, etc. and it is very hard to treat. Treatment of melasma usually has variable results. It may go away on its own in some cases upon stopping the cause (example: cosmetics, sun exposure, contraceptive pills), it may respond to treatment (example: correction of hormone imbalance), or it may be permanent. Currently there is no definitive treatment to make melasma disappear, however there are a few treatment measures to stop formation of new pigmentation and to ensure that melasma does not worsen. These include:

Identifying and stopping the cause:

  • Correction of hormonal imbalances, particularly the ones involving estrogen
  • Stopping contraceptive pills and other medications causing melasma
  • Avoiding cosmetics, make-up, and skincare products with irritants that may aggravate the condition
  • Avoiding tanning beds, exposure to UV light, and LED lights from screen (TV, Laptop, cellphone, etc.)

Medications and combination therapy

Your dermatologist may prescribe specific topical medications with tyrosinase inhibiting properties. The tyrosinase inhibitors prevent formation of new pigments by stopping the production of melanin. The commonly used tyrosinase inhibitors and other agents include:

  • Azelaic acid: Available as gel, cream, or lotion usually advised to apply twice a day
  • Cysteamine: Available as  a cream
  • Hydrocortisone: A corticosteroid for topical application that is effective in fading melasma
  • Hydroquinone: Available as a cream or lotion, usually advised for application at night
  • Methimazole: An effective agent with antithyroid properties used for hydroquinone resistant melasma
  • Soybean extract
  • Topical alpha hydroxy acid: Used for peeling epidermal pigments 
  • Tranexamic acid: Available as an injection, oral medication, or cream 
  • Tretinoin: A retinoid containing agent for topical application 
  • Combination therapy: Hydroquinone combined with tretinoin and a moderate topical steroid. The combination therapy is known to produce the most effective results

Procedures

Your dermatologist may consider performing some procedures to treat your melasma after a thorough assessment of your condition, which may include:

  • Chemical peeling
  • Laser therapy
  • Intense pulsed light

How to prevent melasma?

Unfortunately there is not much you can do to prevent melasma. Identifying the cause and avoiding them is the best way to prevent melasma. Additionally, an appropriate sun protection, and a diet rich in Vitamin D and Vitamin C may be helpful. 

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