Melasma

A diagnosis that I regularly make in and out of the clinic is melasma. While it's a satisfying one to offer to patients, I keep my mouth shut when I notice it on strangers or acquaintances, although I'm curious whether they've noticed the pigmentation changes to their face and whether they know the cause.

Melasma is an acquired increase in pigmentation to exposed body areas, usually the face. It's most often caused by the birth control pill or pregnancy, and is precipitated by sun exposure. It is not painful or itchy - it's a cosmetic issue only.

* Photo from the Color Atlas and Synopsis of Clinical Dermatology. (That volume is quite delightful as a coffee table book, by the way. Guests pore over the images; they can't help themselves.)

Melasma is also known as chloasma or "the mask of pregnancy," and can be striking, as in the patient pictured above. But in my experience, melasma more often presents as a subtler darkening of the cheeks, or as a brownish smudge along the upper lip. If they notice it at all, patients usually attribute it to aging, freckling or tanning.

The macules or patches can range from light brown to black in colour, have well-defined margins, and are  distributed symmetrically. The most common locations are the cheeks (especially below the eyes), the forehead and bridge of nose, and the upper lip.

Darker-skinned individuals and those living in sunny climates are more prone to this skin condition. The incidence among Vancouverites with fair skin is much lower than among Cubans, say. In northern climes melasma may be seasonal, fading over the darker winter months and become more pronounced again in summer.

Discontinuation of the pill or delivery of the baby usually causes the pigmentation to fade over months. (With subsequent pregnancies, the pigmentation tends to return, and to progressively darken.)

Avoiding sun exposure can prevent the onset or worsening of melasma. Sunscreens with an SPF of at least 30 and containing a physical sunblock such as titanium oxide or zinc oxide should be applied liberally and consistently.

Prescription skin bleaching creams can be effective. Hydroquinone 3-4% cream, sometimes in conjunction with tretinoin, may be prescribed for weeks or months.

Patients are impressed when, at the first visit, I know their contraceptive choice the second I lay eyes on them. I've made deductions about some friends and family as well, but haven't yet tested their reactions.

Comments

[nichole]

Hi there,

I followed your link from my blog, and the first thing I saw was this post.

I am no stranger to melasma, and I had it with both pregnancies. It has faded now but I was worried it would be a permanent fixture.

[Lisa G]

Well, it's a very clever, albeit roundabout way of getting them to ask about it! (The friends and family that is.)
You're opening up a big can of worms, though. First, it's asking you about a brown spot (please don't let it be cancer, please don't let it be cancer--- oh, thank goodness!!!) then on to "Hey, Dr. Martina, I've got this itch....."

[mrs. french]

....I haven't been able to fully get rid of mine and I hate it! the bleaching cream makes me nervous....so I guess I will just live with it! ACK!

[Lee]

I have an interest in health (and incidentally, beauty products...lol). But, I stumbled on your site because I was reading some medical blogs. One link led to another, and here I am. I did not know about melasma until a few months ago when I started researching a skin care line called Obagi...you've probably heard of it. Most people have. While I didn't start the Obagi line because I suffer from melasma, some of the Obagi before-and-after photos of people suffering from melasma were astonishing. Their skin after using the line was beautiful--clearer than mine. Incidentally, like you said, the line does include using tretinoin and hydroquinone products...those are probably what does the trick. Not plugging the product because it does have its drawbacks, but from what I've seen it does work wonders. Just thought I'd share. Great blog, btw.