If you feel like your otherwise complexion is being punished by unsightly brown patches that never seem to go away, you are not alone. You may have called ‘melasma’, which is Greek for a black spot. Melasma associated with pregnancy is called ‘chloasma’, also known as "the mask of pregnancy." It is a form of pigmentation on the face sometimes mistaken for a suntan that appears around the cheeks, forehead, upper lip, nose, chin, and jawline. It can also show up on the forearms, but this is quite rare. Although melasma is most common in women of childbearing age, you don’t have to pregnant or even a woman to have it. It is also found in older women who did not have it during their pregnancies, and up to 10% of cases are dark skinned men. Melasma doesn’t really have a cure. In many cases associated with pregnancy, the discoloration fades away after delivery. If you are unlucky, it may persist for longer or indefinitely. The good news is that there are treatments that can be done that can minimize the visible effects and keep them at bay. Successful treatment usually begins with the trio of sunblocks, bleaching creams and time.Above all, sun exposure is the big culprit. Melasma tends to darken in summer after sun exposure, and fade in winter when the sun is a rare treat. This happens because the skin’s pigment, melanin, absorbs the energy of the sun’s UV rays in order to protect the skin from overexposure. Tanning occurs as a result, causing dark areas to get even darker. Melasma occurs more frequently in light brown or bronze skin types from regions of the world with intense sun exposure. As with many beauty concerns like cellulite and acne, genetics plays a major role. More than 30% of sufferers have a family history of it. Skin inflammations from allergic reactions, or waxing of facial hair especially above the lip, can also be a trigger. Some medications can also cause melasma such as the antibiotics tetracycline and minocycline, and some anti-seizure and anti-malarial drugs.
As a rule, any persistent, unexplained darkening or lightening of the skin should be looked at by a Dermatologist. The first step is to determine the cause. A complete medical history and a proper physical examination including evaluating the skin under a Wood’s lamp may be performed. Diagnostic tests, including thyroid function tests and skin biopsies, may also be done. The next step is to eliminate the cause, if possible. For example, if the cause is the medication you are taking, discontinuing it may result in a clearing, but melasma is not always that simple. The pigment may be located in the epidermis or the skin’s outer layer, the dermis or the deeper layer, or a combination of both. The more superficial it is, the easier it will lighten. In general, melasma that is more recent will respond better to treatment
Rule number one is that nothing will be effective if you are still trying to tan, because this completely reverses the process and repigmentation will start again. Hydroquinone 4% is widely considered the most effective skin lightening agent. Don’t self-treat. Some prescription bleaching formulas are marketed to consumers via the Internet, but these should only be used under medical supervision and can cause severe reactions on certain skin types. Lightening agents like kojic acid, derived from fungal or mushroom plants, are often combined with other ingredients like azelaic acid, glycolic acids, lactic acid, retinol, ascorbic acid, and botanical lighteners such as licorice extract and bearberry extract. Most skin lightening ingredients work better in tandem than on their own. For example, glycolic acid helps draw lightening agents into the skin better.
Skin lightening is not a quick process. Depending upon how dark the area is compared with your normal skin tone, it can take six months to one year to see results. Non-prescription lightening creams can go only so far in improving the appearance of melasma. If you are seeking more dramatic improvement, you may have to look to more invasive remedies performed mostly by dermatologists and plastic surgeons. Superficial glycolic peels, trichloracetic acid peels (TCA), microdermabrasion, and intense pulsed light treatments are the most common methods used to even out skin pigment. These treatments tend to be more risky for darker skin types.
The most important lesson to learn to avoid brown patches is to wear sunscreen with a minimum SPF15 all day, every day, year-round. Even incidental exposure such as through your car window on an overcast day can exacerbate melasma. The most effective sunscreens, including zinc oxide and titanium dioxide, should be applied every two hours and not just once in the morning. Consider SPF in your moisturizer and foundation as just icing on the cake. It is not enough to protect you all day long. Minimizing sun exposure can prevent darkening of existing dark patches, as well as the appearance of new areas. This is especially important for women who take birth control pills or hormone supplements or for past melasma sufferers. Once you have successfully lightened up your dark areas, maintenance is needed to keep the skin clear for the long term.
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