Melasma
Encyclopedia
Melasma is a tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications. It is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian and Jewish descent (on the face).
s or pigment-producing cells by the female sex hormones estrogen
and progesterone
to produce more melanin
pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
Genetic predisposition is also a major factor in determining whether someone will develop melasma.
The incidence of melasma also increases in patients with thyroid disease
. It is thought that the overproduction of melanocyte-stimulating hormone
(MSH) brought on by stress can cause outbreaks of this condition. Other rare causes of melasma include allergic reaction to medications and cosmetics.
Melasma Suprarenale (Latin - above the adrenals) is a symptom of Addison's disease, particularly when caused by pressure or minor injury to the skin, as discovered by Dr. FJJ Schmidt of Rotterdam in 1859.
in the epidermis can be distinguished from that of the dermis.
Treatments to hasten the fading of the discolored patches include:
In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.
Cosmetic cover-ups can also be used to reduce the appearance of melasma.
1 Photodynamic therapy with low-strength ALA, repeated applications and short contact periods in acne, photoaging and vitiligo
by Gabriel Serrano, Matilde Lorente, Madga Reyes, Fernando Millan, Adrian Lloret, Joaquin Melendez, Maria Navarro, Miguel Navarro
Symptoms
The symptoms of melasma are dark, irregular well demarcated hyperpigmented macules to patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.Cause
Melasma is thought to be the stimulation of melanocyteMelanocyte
-External links: - "Eye: fovea, RPE" - "Integument: pigmented skin"...
s or pigment-producing cells by the female sex hormones estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
and progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
to produce more melanin
Melanin
Melanin is a pigment that is ubiquitous in nature, being found in most organisms . In animals melanin pigments are derivatives of the amino acid tyrosine. The most common form of biological melanin is eumelanin, a brown-black polymer of dihydroxyindole carboxylic acids, and their reduced forms...
pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
Genetic predisposition is also a major factor in determining whether someone will develop melasma.
The incidence of melasma also increases in patients with thyroid disease
Thyroid disease
-Hyper- and hypofunction:Imbalance in production of thyroid hormones arises from dysfunction of the thyroid gland itself, the pituitary gland, which produces thyroid-stimulating hormone , or the hypothalamus, which regulates the pituitary gland via thyrotropin-releasing hormone . Concentrations of...
. It is thought that the overproduction of melanocyte-stimulating hormone
Melanocyte-stimulating hormone
The melanocyte-stimulating hormones are a class of peptide hormones that are produced by cells in the intermediate lobe of the pituitary gland...
(MSH) brought on by stress can cause outbreaks of this condition. Other rare causes of melasma include allergic reaction to medications and cosmetics.
Melasma Suprarenale (Latin - above the adrenals) is a symptom of Addison's disease, particularly when caused by pressure or minor injury to the skin, as discovered by Dr. FJJ Schmidt of Rotterdam in 1859.
Diagnosis
Melasma is usually diagnosed visually or with assistance of a Wood's lamp (340 - 400 nm wavelength). Under Wood's lamp, excess melaninMelanin
Melanin is a pigment that is ubiquitous in nature, being found in most organisms . In animals melanin pigments are derivatives of the amino acid tyrosine. The most common form of biological melanin is eumelanin, a brown-black polymer of dihydroxyindole carboxylic acids, and their reduced forms...
in the epidermis can be distinguished from that of the dermis.
Treatment
The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.Treatments to hasten the fading of the discolored patches include:
- Topical depigmenting agents, such as hydroquinoneHydroquinoneHydroquinone, also benzene-1,4-diol or quinol, is an aromatic organic compound that is a type of phenol, having the chemical formula C6H42. Its chemical structure, shown in the table at right, has two hydroxyl groups bonded to a benzene ring in a para position. It is a white granular solid...
(HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melaninMelaninMelanin is a pigment that is ubiquitous in nature, being found in most organisms . In animals melanin pigments are derivatives of the amino acid tyrosine. The most common form of biological melanin is eumelanin, a brown-black polymer of dihydroxyindole carboxylic acids, and their reduced forms...
.
- TretinoinTretinoinTretinoin is the acid form of vitamin A and is also known as all-trans retinoic acid or ATRA. It is a drug commonly used to treat acne vulgaris and keratosis pilaris. It is available as a cream or gel...
, an acidAcidAn acid is a substance which reacts with a base. Commonly, acids can be identified as tasting sour, reacting with metals such as calcium, and bases like sodium carbonate. Aqueous acids have a pH of less than 7, where an acid of lower pH is typically stronger, and turn blue litmus paper red...
that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
- Azelaic acidAzelaic acidAzelaic acid is an organic compound with the formula 72. This saturated dicarboxylic acid exists as a white powder. It is found in wheat, rye, and barley. It is a component of a number of hair and skin conditioners.-Production:...
(20%), thought to decrease the activity of melanocytes.
- Chemical peels.
- Microdermabrasion to dermabrasion (light to deep).
- Galvanic or ultrasound facials with a combination of a topical crème/gel. Either in an æsthetician's office or as a home massager unit.
- Laser treatment. A Wood's lamp test should be used to determine whether the melasma is epidermal or dermal. If the melasma is dermal, FraxelFraxelFraxel Laser Treatment is a non-surgical technique for facial rejuvenation.-References:*Hayt, Elizabeth , The New York Times. Accessed June 19, 2010...
laser has been shown in studies to provide improvement in many patients. Intense pulsed lightIntense pulsed lightIntense pulsed light , is a technology aimed at producing light of high intensity during a very short period of time. It involves specific lamps together with capacitors whose rapid discharge provides the high energy required....
has also been effective in the treatment of melasma. Dermal melasma is generally unresponsive to most treatments, and has only been found to lighten with products containing mandelic acidMandelic acidMandelic acid is an aromatic alpha hydroxy acid with the molecular formula C6H5CHCO2H. It is a white crystalline solid that is soluble in water and polar organic solvents. It is a useful precursor to various drugs...
(such as Triluma cream) or FraxelFraxelFraxel Laser Treatment is a non-surgical technique for facial rejuvenation.-References:*Hayt, Elizabeth , The New York Times. Accessed June 19, 2010...
laser or Triwings LED system (Violet Red Yellow color).
In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.
Cosmetic cover-ups can also be used to reduce the appearance of melasma.
See also
- Linea nigra
- HyperpigmentationHyperpigmentationIn dermatology, hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.-Causes:Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris...
in Addison's DiseaseAddison's diseaseAddison’s disease is a rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones... - List of cutaneous conditions
External links
- Melasma Treatment Options - Melasma Treatment
- Health In Plain English - Melasma or Chloasma
- MSM for Melasma - Megadoses of sulphur helps some sufferers
1 Photodynamic therapy with low-strength ALA, repeated applications and short contact periods in acne, photoaging and vitiligo
by Gabriel Serrano, Matilde Lorente, Madga Reyes, Fernando Millan, Adrian Lloret, Joaquin Melendez, Maria Navarro, Miguel Navarro