Unmasking Melasma!
What is Melasma? The most common causes of Melasma. How to prevent and treat Melasma naturally?
Melasma is sometimes called “ Pregnancy Mask” because an increase in hormones in pregnant women sometimes triggers it. But while the condition may be shared among pregnant women, it isn't limited to them. Melasma can affect women and men at all stages of life.
Another, less common name for melasma, is chloasma. Although this disorder is completely harmless, it understandably makes some people feel self-conscious.
What is Melasma?
If you have Melasma you’re probably experiencing light brown, dark brown, and/or blue-gray patches on your skin. They can appear as flat patches or freckle-like spots. Commonly affected areas include your face, including the cheeks, upper lip, and forehead, as well as the forearms. Melasma typically darkens and lightens over time, often getting worse in the summer and better in the winter.
Melasma is a very common skin disorder, especially among pregnant women. 15% to 50% of pregnant women get it. Between 1.5% and 33% of the population may get melasma and it happens more often during a woman’s reproductive years and rarely happens during puberty. It usually starts between 20 and 40 years of age.
Fairer-skinned people are less likely to be affected by melasma than those with darker brown skin or those who tan well. Women are more likely to get melasma than men: about 10% of those who get melasma are men, and 90% are women. Pregnant women get melasma more often than anyone else. You’re also at risk if you take oral contraceptives and hormones.
How does Melasma form in the skin?
The skin is made up of three layers. The outer layer is the epidermis, the middle is the dermis, and the deepest layer is the subcutis. It’s an organ – the largest organ in the body and acts as armor. It protects the bones, muscles, organs, and everything else from the cold, germs, sunshine, moisture, toxic substances, and injury. It also helps to regulate body temperature and prevents dehydration in the body.
The epidermis contains cells called melanocytes that store and produce a dark color (pigment) known as melanin. In response to light, heat, ultraviolet radiation, or hormonal stimulation, the melanocytes produce more melanin, and that’s why your skin darkens.
There are three types of melasma and they have to do with the depth of the pigment. The three types of melasma are:
Epidermal: Epidermal melasma has a dark brown color, and a well-defined border, and sometimes responds well to treatment.
Dermal: Dermal melasma has a light brown or bluish color, a blurry border, and doesn’t respond well to treatment.
Mixed melasma: Mixed melasma, which is the most common of the three, has both bluish and brown patches, and shows some response to treatment.
Melasma is a chronic disease of the skin, caused by melanogenesis dysfunction. Although medically considered a benign lesion, the aesthetic complication of melasma can impair women’s quality of life.
What causes Melasma?
There are three main causes of Melasma:
Radiation, whether ultraviolet, visible light, or infrared (heat) light.
Hormones. Increased Estrogen levels
Iron and Vitamin B12 deficiency.
Other possible causes of melasma include:
Birth control: Melasma has been observed in individuals who use oral contraceptive pills that contain estrogen and progesterone.
Genetics: About 33% to 50% of people with melasma have reported that someone else in the family has it. The majority of identical twins both have melasma.
Hypothyroidism: A condition where your thyroid is underactive.
Pregnancy: It is unclear why “the mask of pregnancy” happens to pregnant women. However, experts theorize that the increased levels of estrogen, progesterone, and melanocyte-stimulating hormones during the third trimester of pregnancy play a role.
Phototoxic drugs (medicines that make you sensitive to sunlight): These include some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycaemics, antipsychotics, targeted therapies, and some other drugs.
Skin care products: A product that irritates your skin, in general, will likely make your melasma worse.
Tanning beds: The UV light produced by tanning beds damages your skin just as bad as the UV light from the sun, and sometimes worse.
Antiseizure medications: Drugs that prevent you from having seizures may be a cause of melasma.
Do certain foods affect melasma?
At this time no foods or drinks are known by experts to directly cause, magically cure or worsen melasma. However, to keep your skin healthy in general, try a skin-healthy diet of foods rich in Vitamin D:
Almond milk.
Eggs.
Meat.
Milk.
Mushrooms.
Oily fish.
Orange juice.
Yogurt.
Is there a cure for melasma?
Melasma is hard to treat. To determine a treatment plan, your skincare provider will have to first figure out what’s possibly causing the melasma. Is it sunlight? Your birth control? Genetics?
Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months. Most cases of melasma will fade away with time and especially with good protection from sunlight and other sources of light.
Unfortunately, there is no definitive treatment that will automatically make melasma disappear. At this time there is no way to remove dermal pigment.
Hormone treatments, specifically ones that involve estrogen.
Birth control, specifically oral contraceptive pills contain estrogen and progesterone.
LED light from your television, laptop, cell phone, and tablet.
Makeup you find irritating to your skin.
Medications that may cause or worsen melasma.
Scented soaps.
Skin care products that irritate your skin.
Tanning beds.
Waxing, which can aggravate the melasma.
How to treat Melasma successfully?
The first thing you need to do to treat your melasma is to make sure that it doesn’t get any worse. Do this by avoiding the sun, tanning beds, LED screens, irritating soaps, and birth control that includes hormones. If you are exposed to the sun, be sure to wear sunscreen with iron oxides and an SPF of 30-50 applied every two hours, as well as a wide-brimmed hat. These steps may prevent your melasma from getting worse.
The second path to take is topical medications. Topical therapy using tyrosinase inhibitors prevents new pigment formations by stopping the formation of melanin (the dark color). Examples of tyrosinase inhibitors and other types of helpful agents include:
Azelaic acid: This cream, lotion, or gel is applied twice a day. It’s safe for pregnant women to use.
Hydrocortisone (a topical corticosteroid): Hydrocortisone helps fade the color caused by melasma. It can also lessen the likelihood of dermatitis that may be caused by other agents.
Hydroquinone: This medication is applied as a cream or lotion. It goes directly onto the melasma patches at night for two to four months. It's important to note that I am personally against the use of Hydroquinone because of the levels of toxicity this agent can cause to the internal organs of the body.
Soybean extract: Soybean extract is thought to reduce the transfer of color from the melanocytes to the skin cells.
Topical alpha hydroxy acids: Epidermal pigments can be peeled off. This cream or chemical peel removes surface skin.
Tretinoin: This prescription is a topical retinoid. It’s effective, but can cause dermatitis and should not be used during pregnancy.
Other agents that are being studied to improve melasma include:
Absorbic acid (vitamin C).
Arbutin.
Deoxyarbutin.
Glutathione.
Kojic acid or kojic acid dipalmitate.
Licorice extract.
Mequinol.
Resveratrol.
Runicol.
Zinc sulfate.
Recommended skin care regimen for Melasma.
We have successfully treated clients with Melasma with at-home skincare regimens tailored to even out uneven pigmentation in the skin, supply the skin with nutrients and inhibit abnormal melanin production.
Our recommendations are:
What vitamins can I take to help with melasma?
Vitamin D helps keep your skin healthy in general. Your healthcare provider might test your vitamin D levels to make sure that you’re getting enough of it from high-vitamin D foods such as meat, cereals, oily fish, and eggs. You could also take a vitamin D supplement. Start at 2,000 International Units (IU) per day.
Will melasma go away if I go off birth control?
If the hormones in your contraception are the cause of your melasma then, yes, it may go away. Typically it takes about three or more months for the melasma to fade.
Will melasma go away after I give birth?
Melasma will likely fade within three months after you’re no longer pregnant.