Melasma - Symptoms, Causes and Treatment

Melasma, also called chloasma, is a type of brownish spot that appears on areas exposed to the sun, especially on the face.

Melasma occurs most often in women, especially those with the darkest skin. Areas such as neck, neck and arms can also be affected. Although it has no consequences to the body, melasma can have devastating emotional and psychological results for its patients.


What causes melasma?

The exact cause of melasma is not known, but there are many factors that can increase the risk of developing these spots on the face, being genetic predisposition, sun exposure and hormonal stimulation, the main ones.

Hormonal factors such as pregnancy, use of hormonal contraceptives (pills, Mirena IUD, adhesives, etc.), postmenopausal hormone replacement therapy and thyroid disorders are the most common. Men may also have melasma, although this is far less common.

What occurs is that melanocytes (skin cells responsible for the production of melanin, skin coloring substance) from the stained areas begin to work exaggerated under normal stimuli, producing too much melanin, causing localized darkening of the skin.

This excess pigment can localize to the epidermis (the most superficial layer of the skin), the dermis (the deepest layer of the skin) or both, determining epidermal, dermal or mixed melasma, respectively. This classification is useful because it helps the doctor predict the degree of success of the treatment, since the deeper the pigment is located, the more difficult it is to reach it.

In addition to the depth classification, facial melasma usually follow specific patterns, so that it can also be classified into:
  • Melasma centrofacial: when it involves forehead, cheeks, nose, upper lip and chin.
  • Melasma malar: when it involves cheeks and nose.
  • Mandibular melasma: when it involves areas around the mandible.

Treatment of melasma

There is no cure for melasma, that is, there is nothing that will make the blemishes disappear forever. The good news is that it is possible to lighten them by as much as 100% depending on the case, and if the sunscreen is adequate, they will hardly come back.

To understand how melasma treatment works, we need to know how melanin is produced.

In normal skin, we can imagine that melanocytes are the machines of a factory that produces pigment. In order to function, these machines need fuel (sun) and, when ready, the final product (melanin) is stored in the stock (more superficial layers of skin: epidermis and dermis). Hormones function as the oil that lubricates the machines (without it, the machines may not work perfectly).

It turns out that in melasma, these machines become very effective and economical, that is, with a minimum amount of fuel, they begin to produce enormous amounts of melanin, which accumulate and occupy the entire stock.

Thus, melasma treatment is based on (1) cutting the fuel from these machines (sun protection), (2) attempting to sabotage these machines by making them slower (use of depigmenting creams and lotions), (3) (dermatological practices such as peelings and lasers) and (4) eliminate the use of hormones as much as possible.

Sun protection is not limited to the use of sunscreens, although they are fundamental. It is important to know that NO sunscreen protects 100% of solar radiation and that people with melasma can darken their spots with a minimum amount of sun. Hence the importance of wearing hats and sun shades, covering totally the affected areas.

Many are the substances that help to lighten the skin. They generally act by inhibiting one or more steps of the chemical reactions that occur within the melanocyte and result in the formation of melanin. The most common are hydroquinone, retinoic acid and azelaic acid - these and other active ingredients can be used in creams, gels and lotions for home use. In this way, the formation of new pigment is difficult. It is important to note that these products should be used throughout the affected area and not just in the spots.

To eliminate staining, procedures should be performed to remove layers of skin impregnated with excess melanin. For this, chemical peels , microdermabrasion, and, rarely, intense pulsed light sources and lasers can be used. These procedures should be done in several sessions, always avoiding too much aggression to the skin because aggressive procedures can cause excessive inflammation of the skin, generating new spots. Unfortunately, when the pigment is too deep, these procedures are not able to reach it.

Finally, women with melasma should prefer non-hormonal contraceptives, such as the copper IUD and barrier methods. In addition, pregnant women and everyone who starts using hormones should intensify daily sun protection, thus preventing the onset of the problem.

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