Introduction
Melasma is a type of skin disorder that is characterized by gray to brown patches or spots on the skin (face). It usually cures after a few months without any treatment, and some management treatment is also available for melasma. Malesma is caused by the increased production of cells in the face, the cells responsible for skin color. The patches produced are different in color from the normal skin color. It is also called chloasma.
What Are the Symptoms of Melasma?
Brown to gray patches on the cheeks, forehead, arms, chin, neck, and nose. It does not harm people but feels in the skin due to the skin's color changes. Sometimes, the patches are red. This condition occurs most in women only; when it is produced in pregnant women, it is called a mask of pregnancy. Malesma gets worse in the summer and winter seasons. It also affects women who take hormone supplements and oral contraception.
What Are the Causes of Melasma?
Genetics, ultraviolet (UV) light, pregnancy, hormonal treatments, cosmetics, phototoxic medicines, and antiseizure medications are the causes of melasma. The female sex hormones progesterone and estrogen activate melanocytes (responsible for color in the skin) in melasma, causing the skin to produce more melanin pigments when exposed to the sun.
Melasma is an acquired form of hyperpigmentation where there is a formation of dark brown patches and spots on the skin of the face and sun-exposed areas. When it is induced by pregnancy, it is called chloasma. It is more common in women, especially those in their reproductive years, but about 10 % of the cases occur in men as well.
What Are the Clinical Features of Melasma?
It is seen as irregular macular (flat, not raised) lesions of brown, blue-gray, or brown-gray color that may occur in three patterns:
1. Centrofacial: Involving the forehead, cheeks, upper lip, nose, and chin.
2. Malar pattern: Involving the cheeks and nose.
3. Mandibular pattern: Involving the jaw.
Course of Melasma
Melasma usually runs a chronic course, exacerbated by sunlight and artificial UVA and UVB light. Women have reported varying degrees of melasma during several pregnancies. Usually, melasma slowly resolves following childbirth or upon discontinuation of oral contraceptives.
What Are the Types of Melasma?
Based on Wood’s lamp examination of the skin, melasma can be divided into:
Epidermal: In this type, melanin (the pigment that synthesizes melanocytes responsible for the pigmentation of the skin) deposition mainly occurs in the basal or suprabasal layer of the epidermis.
Dermal: Melanin-laden macrophages are found in the superficial and mid-dermis.
Mixed: Melanin is found in both the epidermis and dermis.
How Do Dermatologists Diagnose Melasma?
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To identify melasma, a physical examination of an individual is necessary for the signs of red or brown patches in the skin, which is recognized by a dermatologist.
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A dermoscopy is a specialized device used to check for spots or patches on the skin. It is placed on an individual's skin, and this device helps to find how the patches affect the skin and how deeply they are formed on the skin. This finding is important in curing the disease melasma.
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In rare cases, a skin biopsy is used to find the disorder, and a skin pinch is collected for testing.
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Wood’s lamp examination is a device that consists of a light, and it is placed on the skin to find bacterial or fungal infections; how deeply the infection affects the skin is determined.
What Is the Treatment for Melasma?
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The individual should avoid sun exposure as much as possible and follow certain sun-protection measures like avoiding the midday sun (especially between 10 AM and 4 PM), seeking shade whenever possible, and wearing a broad-brimmed hat whenever out in the sun.
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Treatment of melasma during pregnancy or breastfeeding is not advisable.
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Sunscreen, usually broad spectrum with an SPF of more than 30, noncomedogenic, oil-free base should be preferred. It should be applied 30 minutes before going out in the sun and repeated every fourth hour for its full efficacy.
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Topical Hydroquinone cream 2 % should be used during the night. This is suitable for superficial or epidermal melasma.
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A combination of Hydroquinone cream 2 % Tretinoin/ Isotretinoin 0.025 %, and Hydrocortisone cream 0.05 % (Kligman’s regime) is better for deeper or dermal melasma.
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Topical Azelaic acid, either alone or in combination with Isotretinoin can be used.
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Chemical peeling 35 to 70 % Glycolic acid (GA peel) or 10 to 15 % Trichloroacetic acid peel (TCA peel) can be used.
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Lasers like fractional CO2 and Q switched Nd YAG lasers are, in recent times, the treatment of choice for resistant melasma.
What Sunscreen Should Melasma Patients Use?
Sunscreen is used to prevent damage and reduce the irritation of the skin. The best sunscreen for melasma should contain both physical and mineral sunscreen; it is better if it has zinc and titanium dioxide. It eliminates UV radiation and prevents it from causing melasma. Zinc oxide and titanium dioxide are best for melasma because they prevent the skin's absorption of sunlight or UV radiation and cause less irritation.
An essential adjuvant treatment to stop hyperpigmentation from getting worse and to make these disorders seem better has only one treatment, sunscreen, which offers both ultraviolet and VL (visible light) protection. To achieve the best possible results for patients, researchers also need to develop better broad-spectrum sunscreens and provide guidance on how to apply and utilize them.
Conclusion
Wearing a cloth that covers the skin is important for preventing melasma in people. Combining three creams includes hydroquinone to balance the skin tone, a corticosteroid to decrease skin irritation, and tretinoin. Azelaic acid or vitamin C are some examples of medications that a dermatologist would recommend that are softer on the skin. Using sunscreen on the skin is the most recommended treatment for melasma, and the sunscreen needs to contain iron, titanium, and zinc oxides.
