Melasma or Chloasma or Mask of Pregnancy is a common skin discoloration, which appears as a brown/ tan or bluish to grayish patches usually seen on forehead, upper cheeks, upper lip and chin. Melasma commonly affects women of reproductive age, i.e. between 20-45 years old. It can also occur in males; however, it is very rare.
Melasma or Chloasma or Mask of Pregnancy is thought to occur as a result of hormonal changes in women, such as during pregnancy, taking birth control pills, HRT and exposure to the sun. Melasma commonly occurs in pregnant females, particularly of Asian and Latin origin. Individuals having darker or olive skin, (Asian, Hispanic, Middle Eastern) are more prone to having melasma.
Treatment comprises of sun protection and regular use of sunscreen. Medicines such as fading creams are also prescribed.
Causes of Melasma or Chloasma or Mask of Pregnancy
The exact cause of Melasma or Chloasma or Mask of Pregnancy is not known. According to research, melasma and the dark patches within it is triggered by various factors, such as birth control pills, pregnancy, hormone replacement therapy(HRT), having a family history of melasma, ethnicity, medications for seizure and other such medications which make the skin vulnerable to pigmentation upon sun exposure or UV rays (ultraviolet) exposure. Continuous exposure to sunlight is thought to be the primary cause of melasma, particularly in those people who already are predisposed to melasma genetically. According to research, melasma is found to occur more in the summer and is less apparent or lighter in the winter.
Melasma occurring in the pregnancy is known as chloasma, also known as "the mask of pregnancy." In pregnancy, there is increase in hormones, such as progesterone, estrogen, and MSH or melanocytes-stimulating hormone leading to chloasma. In addition, products or treatments that irritate the skin may cause an increase in melanin production and accelerate melasma symptoms.
As mentioned before, individuals who have a family history of melasma are at a higher risk for developing melasma. Prevention should be taken by using sun block or sunscreen to avoid triggering the production of pigment. Such patients should also discuss with their doctor about avoiding HRT and birth control pills.
Location of Melasma or Chloasma or Mask of Pregnancy
Melasma or Chloasma or Mask of Pregnancy is the hyperpigmentation or discoloration seen mainly on the face. There are 3 types of facial patterns seen in melasma, which are:
- Center of the face or centro-facial.
- On the cheek bones or malar.
- On the jawbone or mandibular.
The centro-facial pattern is the commonest one and includes the cheeks, forehead, nose, upper lip and chin. Cheeks are affected in the malar pattern and the jaw is affected in the mandibular pattern. Other regions which are not commonly involved are forearms and sides of the neck.
Types of Melasma or Chloasma or Mask of Pregnancy
There Are 4 Types Of Pigmentation Patterns In Melasma Or Chloasma Or Mask Of Pregnancy:
- Epidermal: In this type, there is excess melanin present in the top layer of the skin.
- Dermal: In this type, there are melanophages present.
- Mixed: This type is the combination of epidermal and dermal type.
- Unnamed type: In this type excessive melanocytes are found in individuals with dark complexion.
Investigations for Melasma or Chloasma or Mask of Pregnancy
It is easy to diagnose melasma due to its characteristic appearance of brown patches on the face. Dermatologists diagnose melasma by examining the skin with a black light, also known as Wood's light. Most of the times, mixed melasma is present, which means that discoloration is due to the presence of pigment in the epidermis as well as dermis. In rare cases, skin biopsy is done to rule out other causes of hyperpigmentation in the skin.
Treatment for Melasma or Chloasma or Mask of Pregnancy
- Treatment for Melasma or Chloasma or Mask of Pregnancy commonly involves the use of OTC creams which have 2% hydroquinone in them, such as Porcelana, Esoterica etc. They are effective in melasma by lightening the skin. The cream has to be applied on the brown patches twice a day. Sunscreen can be applied over this cream.
- Prescription-strength creams which have 4% hydroquinone in them such as Tri-Luma, Obagi Clear etc. are also used; however, this higher concentration can cause skin irritation.
- There are some sunscreens, which have 4% hydroquinone, e.g. Obagi Sunfader sunscreen.
- Treatment is done for all the melasma types; however, the epidermal melasma type shows better response to treatment than other types of melasma, as the pigment in this type is closer to the surface of the skin.
- Melasma or Chloasma or Mask of Pregnancy can also clear on its own without any treatment; whereas, in some cases, it will disappear with use of sunscreen and avoiding the sun. If melasma is due to taking birth control pills or hormone therapy or pregnancy, then melasma will resolve after the use of hormones is discontinued or after pregnancy.
- A combination of creams with retinoic acid, hydroquinone, azelaic acid, and (tretinoin), non-phenolic bleaching agents, and/or kojic acid is also prescribed.
- For treating severe melasma, creams containing higher concentration of hydroquinone or combining it with other agents like tretinoin, glycolic acid or corticosteroids is effective in lightening the patches of melasma.
- Some of the side effects of melasma treatment are: Temporary skin irritation and ochronosis (if the HQ is used in very high concentration).
- Sunscreen with a minimum SPF of 20 should be used when stepping out in the sun. It is important to use a sunscreen which protects the skin from both the UV-A and UV-B rays. Using sun protection regularly boosts the effectiveness of melasma treatment.
Prevention of Melasma or Chloasma or Mask of Pregnancy
Prevention of Melasma or Chloasma or Mask of Pregnancy can be quite difficult, especially if you have a family history of melasma. However, taking the following steps is helpful:
- Sun, especially on the face should be avoided.
- Always wear sunblock, hats, scarves, sunglasses to protect yourself from sunlight.