Melasma (also known as chloasma) is a common skin condition in which brown discolourations develop primarily on the cheekbones, forehead and upper lip. The tendency to develop melasma is genetically predetermined and anyone who tan easily are most at risk. It commonly occurs after taking birth control pills or during pregnancy but may develop in association with menopause, hormonal imbalance and ovarian disorders. It may also be triggered by a certain epileptic medication but can occur spontaneously and is occasionally seen in men.
Since sunlight is the universal trigger that stimulates melasma in susceptible individuals, lifelong sun avoidance is essential for successful treatment. An SPF 30 broad spectrum sun block, such as Ultraceuticals SPF 30, which also contains physical agents such zinc oxide and titanium oxide, must be applied on a daily basis to protect against not only UVA and UVB rays but also ultraviolet radiation and visible light. Protective hats and clothing should also be worn and direct sun exposure should be avoided within practical limits. It is important to apply your sunscreen every morning, whether or not it is sunny outside or whether you are outdoors or indoors. You are exposed to significant amounts of ultraviolet rays even when just walking down the street, driving in cars, or sitting next to windows. One day of unprotected sun exposure in a person prone to melasma can undo months of treatment.
Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as these may worsen melasma. If melasma develops after starting birth control pills, it may improve after discontinuing them. Alternate contraceptive advice should be sought from you general practitioner.
At night apply the fading cream which has been prescribed for you on freshly cleaned skin. This cream does not “bleach” the skin or destroy pigment producing cells but works by decreasing their activity. This preparation is potentially irritating and should be introduced gradually, initially only every 3rd night, but slowly increasing to nightly as tolerated. Dosages and ingredients may need adjusting up or down as dictated by your clinical response. This cream is not recommended for long term use and should not be used during pregnancy. Alternate products are available for long term maintenance or during pregnancy. Very occasionally, pigmentation may darken during the course of treatment. If darkening occurs, immediately cease applying the melasma cream and report to your treating practitioner.
Laser toning, microdermabrasion and light peeling are recommended as helpful adjuncts in the treatment of melasma. Though strong chemical peels and aggressive laser treatments may help temporarily, results are inconsistent and unpredictable and relapses are common. Because these procedures have the potential to worsen pigmentation, they cannot be recommended.
Melasma is a challenging condition to treat successfully and relapses are common. Fortunately, most people can obtain satisfying results with a combination of lifelong sun avoidance and appropriate topical medications and these results can be maintained by continued use of appropriate skin care products.