Melasma

Melasma is a patchy, hypermelanotic skin disorder that causes a serious cosmetic problem. It tends to occur equally in all races, but the light-brown color characteristic of melasma is most visible on dark-skinned whites. Melasma (also called chloasma or mask of pregnancy) affects women more often than men. It may be chronic but is never life-threatening.

Causes

The cause of melasma is unknown. Histologically, hyperpigmentation results from increased melanin production, although the number of melanocytes remains normal. Melasma may be related to the increased hormonal levels associated with pregnancy, ovarian cancer, and the use of oral contraceptives. Progestational agents, phenytoin, and mephenytoin may also contribute to this disorder. Exposure to sunlight stimulates melasma, but the condition may develop without any apparent predisposing factor.

Symptoms

The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.

Diagnostic tests

Observation of characteristic dark patches on the face usually confirms melasma.

Treatment

The primary treatment is the application of a bleaching agent containing 2% to 4% hydroquinone to inhibit melanin synthesis. This medication is applied twice daily for up to 8 weeks. Adjunctive measures include avoiding exposure to sunlight, using sunscreens, and discontinuing oral contraceptives.

Prevention

Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles.

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