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headshot of a woman smiling with clear perfect skinMany women get melasma, a common skin problem characterized by brown to grey-brown patches on the face and other parts of the body that get lots of sun. The condition is far more common in women, and it often accompanies pregnancy. Because of this connection it is casually known as “the mask of pregnancy.”

Who gets melasma?

Melasma is mostly an issue for women, as only 10% of those who get the condition are men.

It tends to affect people with darker skin tones and there seems to be a genetic element. If you’ve had a blood relative with melasma, you’re far more likely to get it as well.

What causes melasma?

As with other skin conditions such as rosacea, there isn’t a direct cause/effect relationship with melasma. The condition is likely the result of the melanocytes — the skin cells responsible for pigment — overproducing color. That’s why it is believed that people who already have more pigment in their skin are more prone to melasma because their melanocytes are more active than people with fair skin.

There are certain triggers for the dark facial pigmentation of melasma:

  • Hormonal changes— Pregnant women often get melasma due to the extreme changes in their hormones. In a similar fashion, birth control pills and hormone replacement medicines can trigger melasma.
  • Sun exposure— The ultraviolet light from the sun triggers the melanocytes in the exposed skin to produce pigment as a safety mechanism. This is why human skin tans. Once a person with melasma is exposed to some sun, an area that has faded will often become darker again. Because of this, more cases of melasma occur during the summer.
  • Cosmetics— Certain cosmetics can worsen melasma if they irritate the skin.

Signs of melasma

Melasma isn’t a health-impairing condition; its effect is purely visual. Melasma shows itself in brown or grey-brown patches on the skin’s surface.

These are the most common areas:

  • Forehead
  • Cheeks
  • Above the upper lip
  • Chin
  • Bridge of the nose
  • Forearms and neck (less common)

How we treat melasma

Melasma often fades on its own, especially if the patient protects herself from sun exposure. Other triggers such as hormonal fluctuations during pregnancy resolve themselves after delivery or the trigger is removed.

Sometimes, however, the condition persists. Or, if birth control pills were responsible, the woman may want to continue to use them. Then we have various treatment options at the Center for Dermatology and Laser Surgery.

  • Hydroquinone— We use prescription-strength hydroquinone usually as a first option. When applied to the darkened areas, it lightens the skin.
  • Tretinoin and corticosteroids— Beyond hydroquinone, these are the next two steps in enhance skin lightening. Sometimes we will use a cream with all three medicines (hydroquinone, tretinoin, and corticosteroid).
  • Other topical medicines— Azelaic acid and kojic acid also lighten the skin.
  • Procedures— If topical applications don’t seem to be generating the results you seek, we can opt for chemical peels (usually glycolic peels), microdermabrasion, or dermabrasion.

Melasma can be stubborn to eliminate, and it may recur. Sticking with the treatment plan we create is important.

If you have the signs of melasma, call us the Center for Dermatology and Laser Surgery, (503) 297-3440, and let’s take a look.