What is Melasma? Types, Symptoms, and Cure

Not every dark patch is a sign of pigmentation; it can be melasma, a common skin condition causing skin discolouration or dark patches. Melasma can often fade away on its own, but sometimes, it can become a major concern if it starts to spread. 

In this blog, we will explore everything you may want to learn about melasma to better treat it, including underlying causes, types, and treatments. 

What is Melasma

Melasma, also known as chloasma, is a common skin condition identified by dark patches of brown, blue, or grey colour in the form of freckle-like spots. The term is interchangeable with the "mask of pregnancy" due to its frequent chances to affect pregnant women. It is more widespread in darker skin tones than in individuals with lighter skin tones. 

Melasma is no big deal for the skin, usually harmless, and can subside without any treatment. However, if it remains on your skin, skincare ingredients like azelaic acid, hydraquinone, and procedures such as microneedling can make a difference. 

Types of Melasma

A black light may be used to assess the spread of melasma within the layers. There are three types of melasma categorised on the basis of pigmentation depth, how defined its edges, and how it reacts to the treatment. 

1. Dermal Melasma: Suggested by the name, dermal melasma affects the deeper skin layer, the dermis. Identified by a light brown colour, sometimes maybe a little bluish, with a hazy outline, it looks the same under or without the wood's lamp black light. This indicates the melasma is deep and stubborn. Dermal melasma may not go away with a simple, easy treatment. Regular clinical procedures like dermabrasion can be required.
   
   
   
2. Epidermal Melasma: This affects the epidermis, the top layer of your skin and forms uniform and dark patches mainly on the face. When examined under the dark light, patches are visible because they are closer to the skin's surface and accommodate well to the treatment.
3. Mixed Melasma: The most prominent among the three is mixed melasma, which imparts both brown and light blue patches. They can react to the treatment and show characteristics of both mild and intense pigmentation. 
   

Melasma Causes & Triggers 

Some studies believe that iron and vitamin B12 deficiency can cause melasma. While the exact cause of melasma is yet to be determined, multiple factors can contribute to this skin condition, including;

• Hormones: Increased levels of estrogen receptors in melasma lesions can trigger melasma in non-pregnant women, and progestrone given to women going through post menopause can also develop melasma. Low thyroid function or hypothyroidism could also account for melasma. 
• Pregnancy: Pregnant women are at high risk of developing melasma. But the precise reason behind this is still undiscovered. Some experts believe that melanocyte-stimulating hormones, along with progesterone, can be behind this, making it likely to develop during the second or third trimester. 
• Genetics: Individuals with a family member dealing in the family with melasma may encounter it too. Melasma is witnessed in the majority of both identical twins. 
• UV Exposure: Sun exposure can encourage the symptoms of melasma by stimulating the overproduction of melanin. Frequent or prolonged stay under the sun can be harmful. 
• Wrong Skincare Products/Ingredients: Using something that your skin cannot tolerate may cause melasma by irritating the skin. 
• LED Lights: Lights from your digital devices, like phones, tablets, and laptops, can cause melasma. 
  

Melasma Symptoms

Melasma brings about dark-coloured brown-bluish patches on the skin that can be inflamed, itchy or red. They appear like freckles many times. Melasma can develop across different body parts, including 

• neck 
  
• jawline
  
• shoulders 
  
• arms 
  
• Cheeks
  
• nose 
  
• forehead 
  
• upper lip

According to research by the American Academy of Dermatology, women have a 90% higher likelihood of getting affected by melasma compared to men. Individuals are more susceptible to developing melasma if they are;

• women in reproductive age
  
• dark-skinned people
  

How to Treat Melasma

Melasma is treatable, and sometimes goes on its own. If it has happened due to hormonal changes, pregnancy, or certain medications, it usually fades away once these factors return. 

You can get rid of melasma with some effective skincare ingredients, a disciplined routine, and lifestyle changes. However, it can come back once you’re done with the treatment. 

Seeking your doctor is an ideal way to understand your melasma to set up an efficient treatment approach. A few topical ingredients can make a difference to the skin struggling with melasma. Most of them are tyrosinase inhibitors.

• Hydroquinone: It takes around a few weeks to months to show results with this ingredient. It is applied directly to the patches. 
• Azelaic Acid: It's available as a cream, gel, or lotion and is safe for pregnant women to use. 
• Tretinoin: A good option among topical retinoids, this helps to increase cellular turnover and can be combined with hydroquinone. This one is to avoid in pregnancy. 
• Trenexamic Acid: Oral trenexamic acid, cream, or lotion can show a significant but slow difference in melasma spots. Helps with post-acne hyperpigmentation, too. 
• Hydrocortisone: Hydrocortisone can be a temporary solution for the redness and itching associated with melasma. However, it's not s long-term solution. 

Some chemical procedures can have a positive effect on severe melasma, like;

• Non-ablative fractioned lasers, intense pulsed light, and low fluence Q-switched lasers. Your doctor can guide you best on these. Multiple sessions may be required to see significant changes. 
• Chemical peels can allow your skin to regenerate and make it even.
   
  
  
• The microneedling procedure creates tiny cuts in your skin, resulting in a reformed skin tone. 
• Platelet-rich plasma is another procedure or therapy that takes a small amount of blood, processes it in a machine and reintroduces it to your skin with an injection. This heals the skin and makes the complexion brighter and clearer. 

Making some lifestyle changes can improve melasma. Avoid triggers that can encourage redness or worsen the condition, like using digital devices with LED screens from a very close distance, roaming under the sun without SPF for long periods, waxing the skin or using perfumed soaps or other scented products. 

DRSQ's Skin Bright serum has tetrapepride-30 to help with melasma. It evens the skin tone, brightens the complexion and lightens the dark spots. Cleanse your skin with any of the suitable cleansers, apply this Skin Bright serum all over the face and end the regimen with a non-greasy moisturiser.

Hyperpigmentation Vs Melasma

Hyperpigmentation and melasma may look similar on the skin, but they are different. Melasma is a skin condition and a kind of hyperpigmentation that happens primarily due to changes in hormones, and sun exposure can exacerbate the condition even worse. Hyperpigmentation can occur after an acne, due to hormonal imbalances, or even after a skin injury. 

It can occur on any body part, including the legs and back. Manifesting in several patterns like spots, patches, straight streaks, or undefined shapes, hyperpigmentation can occur in mild to severe form. It may or may not need a treatment that includes topical agents, procedures, and therapies. 

Melasma in Pregnancy

Pregnant women have an elevated risk of developing melasma. Accurate reasons behind this are still unknown, but some doctors suggest it may be due to fluctuating hormones, particularly progesterone and estrogen. 

It is most likely to begin in the second to third trimester when one can notice the dark patches on various body parts, including the pubic area, belly, areolas, and around the mouth. A study revealed that melasma affects 15% to 50% of pregnant women. Another study suggests chloasma (melasma during pregnancy) can affect 50-70% of pregnant women. 

FAQs

1. Can vitamin C remove melasma?
   Topical vitamin C can reduce melasma. Though more studies are required to validate this fact and one needs to be consistent with its usage to witness effective results. You can consult your doctor to get a prescription for a tyrosinase inhibitor to fade your melasma patches away. 
   
   
2. Is melasma a form of cancer?
   No, melasma is not a form of cancer or in any way cancerous. It is a harmless skin condition that happens due to overproduction of melanin in the skin. 
   
   
3. Can melasma fade away on its own?
   Yes, melasma often goes away on its own without any treatment. When the causative elements, such as pregnancy or hormonal fluctuations, return, melasma also goes back, but it can take a few months. 
   
   
4. How to cure melasma from the inside?
   You can address the internal factors linked to melasma, like hormonal changes, dietary choices, and getting enough rest. 
   
   Vitamin E, retinoids, carotenoids and unsaturated fatty acids can aid in the condition.
   
   Stress can contribute to the increased estrogen levels, leading to melasma. Managing your stress level is compulsory by trying mind-healing practices and a good, healthy sleep. 

References:

• Clinics in Dermatology, September-October 2009, pages 495-501
• Experimental Dermatology, July 2019, pages 786-794
• Clinics in Dermatology, May-June 2012, pages 335–344
• Journal of Clinical and Aesthetic Dermatology, 2023
• Frontiers in Dermatology, 2023