General Health

Melasma: Prevalence, therapy and prevention

Melasma is a pigmentation disorder of the skin that affects females who have darker skin. It is commonly seen on the face as dark spots or patches with irregular borders. Melasma is not a harmful condition, but certain studies have shown that it can cause psychological problems and poor quality of life due to changes in the physical appearance of females.

Melasma is a common disorder with a prevalence rate of 1%, but the rate can increase up to 50%. Otherwise known as the mask of pregnancy, it is caused by the hormonal changes that occur during pregnancy. Additionally, hormonal medications like birth control pills trigger the production of skin pigments in melasma. Exposure to the sun is another crucial contributor to melasma.

Is Melasma preventable?

Unfortunately, melasma can not be entirely prevented in people likely to develop this condition due to genetics, skin colour, hormones, or sub-exposure level. Avoiding exposure to the sun during peak hours, using high SPF sunscreens, and avoiding hormonal medications can help in protecting against melasma flares and reduce the recurrence after treatment. Protection from the sun is the mainstay of any melasma treatment regimen.

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What sunscreen should melasma patients use?

Choosing an appropriate sunscreen is essential if one develops melasma. Studies have shown that broad-spectrum sunscreens can lower pigment production in the skin in melasma patients as they block visible light and UVA/UVB rays. Non-tinted sunscreens, on the other hand, do not block visible light.

For some people, it is more convenient to use cosmetic products such as foundations that contain UVA/UVB blockers and visible light blockers like iron oxide. These products can conceal dark spots and reduce the psychosocial impact of melasma. At the same time, sunscreen helps to protect against the darkening of the lesions.

Can melasma be treated?

Melasma can not be cured, but several medications and procedures can manage the condition. Knowing these treatment options can result in an incomplete response is essential. Thus the pigments can be lighter or disappear, while some may remain unchanged. Frequent relapses are common.

It is essential to note the side effects of the treatment, including darkening of the skin caused by inflammation induced by treatment or lightening of the skin in a treated area. Using the appropriate medications under a skin expert’s supervision can help achieve treatment gains and maintain them with fewer relapses.

Common melasma treatments

The most commonly used treatment for melasma is skin lightening medications that are applied topically. These include medications like hydroquinone, azelaic acid, kojic acid, niacinamide, cysteamine, and tranexamic acid. These chemicals help to reduce pigment production and inflammation, and by reducing the excessive blood vessels in the skin, they help to prevent the onset of melasma.

Pregnant women should avoid most of the medications except azelaic acid. Hydroquinone can drastically affect the skin but should only be used for a limited time. This is because of the side effects that may happen with prolonged use. However, it can be used for six months for initial treatment and occasionally if needed.

However, in most patients, combination therapy is needed to treat melasma. A typical combination is a hydroquinone with a retinoid that increases the rate of skin cell turnover and a steroid that decreases skin inflammation. In addition, oral medications, including tranexamic acid, are usually considered in severe melasma cases.

Suppose the melasma doesn’t improve even after taking topical and oral medications. In that case, procedures like chemical peeling and laser techniques can be beneficial. Chemical peels use substances like glycolic acid, alpha-hydroxy acids, and salicylic acid to remove the superficial layer of skin that contains excessive pigments in melasma patients. The effects of chemical peel are temporary since this procedure removes the skin’s superficial layer without reducing the pigment production rate. Laser therapies can destroy pigment cells in the skin and lighten melasma’s dark spots. However, the chances of relapse can not be ruled out completely.

Maintenance therapy and prevention

After achieving improvement in melasma lesions, sun protection and maintenance therapy must be continued. Skin lighteners can be used with retinoids to maintain the results, and hydroquinone therapy may be used intermittently if needed.


Tuhina Mishra

Dr. Tuhina Mishra completed her MBBS from Grant Government Medical College in the year 2021. She has published several research papers in Indian and international journals. She is a recipient of the ICMR-STS award in the year 2019. She is a staunch believer in making research an integral part of the medical curriculum. She has volunteered in several NGOs, healthcare startups, and awareness programs.

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