Melasma is a skin disease which causes dark, patchy and discolored skin surface. It mainly affects the face. It is also known as the mask of pregnancy. It occurs in females during the pregnancy. It also affects the men and people from all the ages and backgrounds. Melasma appears on the cheek, forehead, nose, upper lip and chin.
Epidemiology
Melasma is more common in women. About 90% of the cases are seen in females. It also affects the men but in small %. The rate differs from different population and geographic area. It can occur at any age. It appears during the reproductive years mainly in the age pf 20 to 40 years.
Melasma is more common in U.S. about affect over 5 million people. The prevalence rate is about 8.8% in females of Latino which are living in the southern U.S., 13.4 to 15.5 % in Arab Americans in the Michigan and 40% in south-east Asia.
Melasma can occur at any race of people. It is more common in the dark skin type than the light skin type, specifically in the light brown skin type. The ratio of female to male is about 9:1. About 15 to 50% of the pregnant women may have melasma. The prevalence rate may differ from 1.5 to 33 % on the basis of population.
Hormones play an important role in the development of the melasma. Any changes in the hormone can lead to this condition. Melasma is also known as hormone related or hormone dependent skin disease. UV radiation from the sun is a main factors which can develop melasma. Sun exposure can lead to elevated production of the melanin and lead to dark patches on the skin. People who are living in the areas with a high exposure to sun are at the high risk of this disease.
These is some research which indicate that the genetics may play a role in the melasma. If you have any history of melasma in the family, you are at the high risk of this condition.
Anatomy
Pathophysiology
The most common factor is sunlight exposure. UV radiation increases the production of α-melanocyte stimulating hormones and corticosteroid, IL-1 and endothelin 1. It can increases the production of melanin by the intraepidermal melanocytes. Continuous exposure to the UV light may lead to dermal inflammation and activation of fibroblast in the melasma dermis. This can cause elevated melanogenesis.
The main factor is the excessive production and accumulation of the melanin. Melanin is produces by the melanocytes. It is cells which are located at the basal layer of epidermis. An excessive activity of melanocytes can lead to over production of the melanin in melasma.
Sun exposure can lead to over production of melanin and causes DNA damage because of the UV radiation. It can cause dark patches.
Etiology
Hormones like estrogen and progesterone may affect the activity of melanocytes and lead to stimulation of production of the melanin. Use of hormonal contraceptives, menopause, pregnancy, medications like birth control pills can affect the levels of hormones and lead to melasma.
UV radiation can stimulate the melanocytes and produce an excessive pigmentation and form the dark patches on skin. Sun exposure without proper protection may worse the existing melasma and elevate the risk of development of new patches.
Some studies have indicated that there is a link between thyroid dysfunction and the melasma. The exact process is not known but thyroid hormone may affect the production and distribution of the melanin in the skin.
Genetics
Prognostic Factors
Melasma is more common in dark skin type specifically Fitzpatrick skin type III to VI. Asian, Middle Eastern, African, and Hispanic are more prone to develop the melasma.
Melasma is not linked with mortality and morbidity. Patients who have melasma are at the low risk of developing the melanoma.
Clinical History
Melasma can occur on the area which is exposed to the sun as acquired hypermelanosis. It is a symmetrical distributed hyperpigmentation macules which are punctate. It gets worse if the area gets the excessive sun exposure like cheek, upper lip, chin and forehead.
Women whose age is 20 to 40 years are in the phase of pregnancy and linked with changes in the hormones or taking the contraceptives may get the disease. It is necessary to get the proper diagnosis and prognosis from the dermatologist if you have melasma or other skin disease.
Physical Examination
The healthcare provider will take the detailed medical history about aby earlier skin diseases, medication, family history of melasma or any other skin disease or factors which can contribute to the condition.
The healthcare provider will assess the affected area of the skin like face, forehead, cheek, chin, upper lip, nose. The patches can have symmetrical distribution.
Dermatoscopy or dermoscopy is a non-invasive method which allows the healthcare provider to assess the surface of the skin by using magnifying tool dermatoscope. It assesses the pigmentation of the kin and structure which can be beneficial in the diagnosis.
Age group
Associated comorbidity
Associated activity
Hormonal changes: Melasma is often associated with hormonal fluctuations, particularly during pregnancy (chloasma or “mask of pregnancy”) or while taking hormonal contraceptives. Hormones like estrogen and progesterone can stimulate melanocytes (cells responsible for producing melanin), leading to increased pigmentation in susceptible individuals.
Sun exposure: Sunlight can stimulate melanin production, exacerbating the patches and making them more visible. Individuals with melasma must prioritize safeguarding their skin against the sun by employing broad-spectrum sunscreen, donning protective clothing, and steering clear of peak sun hours.
Family history: Melasma may have a genetic component, and individuals with a family history of the condition may be more prone to developing it themselves.
Thyroid disorders: There may be a link between melasma and thyroid dysfunction, although the exact mechanism is not fully understood.
Acuity of presentation
Melasma mainly gradually increase over the time. The patched becomes more darker after the exposure to sun.
Differential Diagnoses
Actinin Lichen Planus
Acanthosis Nigricans
Solar Lentigines
Post-inflammatory hyperpigmentation
Poikiloderma of Civatte
Ochronosis and Alkaptonuria
Nevi of Ota and Ito
Mastocytosis
Lichen Planus pignemtosus
Hori Neus
Frictional Melanosis
Fixed drug eruptions
Exogenous Ochronosis
Erythema Dyschromic Perstans
Drug induced photosensitivity
Contact dermatitis, pigmented
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Sun Protection: The 1st step is to avoid sun exposure and protection from the sun to treat melasma. Patient can use broad spectrum sunscreen which has a high SPF sun protection factor like SPF 30 or 50 and reapply it in every 2 hours when exposed to the sunlight. Sun protective cloth, wide hats and sunglasses are suggested.
Topical Agents: Topical agents are the 1st line of treatment. It gives the light effect to the hyperpigmented area and decrease the production of melanin. The most common topical agents are:
Hydroquinone: It is a depigmented agent which inhibits the synthesis of melanin. It is available in different strengths. Long term usage must be monitored by the dermatologist because of the side effects.
Retinoids: Tretinoin is a topical retinoid which can help to increase the penetration of other agents and stimulates the skin cell turnover.
Azelaic Acid: It has both depigmentation and anti-inflammatory properties. It is sued as an alternative treatment or along with hydroquinone.
Kojic Acid, Vitamin C, and Licorice Extract: These are the natural skin lighting agents. It can be used as a topical agents to increase the results.
Chemical Peels: It is a cosmetic procedure which are administered on the outer layer of the skin. It exfoliates the skin and stimulate the regeneration of the fresh skin cells. Artificial and medium depth chemical peels like salicylic acid, glycolic acid or trichloroacetic acid (TCA) may treat the melasma by exfoliating pigmented areas.
Combination Therapy: Combination of the treatment can be more effective to manage melasma. A dermatologist creates a customized treatment plan which includes a combination of the topical agents, laser treatment and chemical peels to get the good results.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
lifestyle-modifications
Sun protection: Melasma is often triggered or worsened by exposure to the sun’s ultraviolet (UV) rays. Use broad-spectrum sunscreen with a high SPF (30 or higher) daily, even on cloudy days. Reapply sunscreen every two hours, especially if you are outdoors. Additionally, wear wide-brimmed hats, sunglasses, and protective clothing to minimize sun exposure.
Avoid peak sun hours: Try to stay indoors or seek shade during peak sun hours, Usually, the period from 10 am to 4 pm experiences the most intense sunlight due to the sun’s powerful rays.
Minimize heat exposure: Prolonged exposure to heat can worsen melasma. Stay in cool environments and avoid hot showers or baths.
Gentle skincare products: Use mild and gentle skincare products that do not irritate the skin. Avoid harsh scrubs, exfoliants, or astringents that may worsen melasma.
Avoid hormone-triggering factors: Hormonal fluctuations, such as those occurring during pregnancy or with certain medications, can contribute to melasma. If you are on hormonal medications, discuss alternative options with your doctor.
Use of Hydroquinone agents to treat Melasma
Hydroquinone is widely used agent to treat melasma. It is a depigmented agent which inhibits the activity of melanocytes which can produce the melanin. It is available in different forms like gels, lotion, creams, and serum.
Effectiveness of Triple combination cream to treat Melasma
Hydroquinone: This acts as a skin lighting agent. It inhibits the production of melanin. It helps to decrease the dark patches and hyperpigmentation linked with the melasma.
Tretinoin (Retinoid): Tretinoin is a derivative of vitamin A. It increases the skin cell turnover and leads to the even skin tone and renewal of the skin.
Fluocinolone: Fluocinolone is a corticosteroid medication which is used in triple combination cream.
Effectiveness of Non-hydroquinone agents in treating Melasma
Azelaic acid
Azelaic acid decreases the synthesis of melanin. It plays an important role in the determination of skin color. Azelaic acid helps to light the hyperpigmented areas. It also has anti-inflammatory effects which reduces the inflammation linked with melasma. It removes the dead skin because of the mild exfoliating effects. Azelaic acid creams come in different concentrations like 15 % or 20%.
Kojic acid
Kojic acid inhibits the tyrosinase enzyme. It plays an important role in production of melanin. Kojic acid reduces the production of melanin and fades the dark spots and promotes even skin tone.
Kojic acid has antioxidant property. It contains free radical which can reduces the oxidative stress on the skin and prevent the darken effects on the patches.
Niacinamide
Niacinamide inhibits the conversation of melanin from melanocytes to keratinocytes. It prevents the excessive pigmentation and reduces the patches on the skin by reducing the transfer of melanin. It also has anti-inflammatory property. It smooths the skin and reduces the redness and irritation of the skin.
Rucinol
Rucinol inhibits the activity of tyrosine. Tyrosine converts the tyrosine in different forms of melanin. Rucinol reduces the production of melanin by inhibiting this enzymes in the skin cells. It leads to the lighting effects on the hyperpigmented area of the skin.
Cysteamine
Cysteamine interferes with the mechanism of production of melanin. It inhibits the activity of melanocytes and reduces the synthesis of melanin. It has antioxidant property. It neutralizes the free radicals in the skin and reduces the dark patches.
Undecylenoyl phenylalanine:
Undecylenoyl phenylalanine inhibits the activity of tyrosine. It reduces the production of melanin by inhibiting this enzymes in the skin cells. It leads to the lighting effects on the hyperpigmented area of the skin.
It also interferes with the transfer of melanin from melanocytes to keratinocytes and reduces the pigmentation on the affected areas.
Topical methimazoleÂ
Topical methimazole is mainly used to treat hyperthyroidism. Methimazole inhibits the production of thyroid hormones in the thyroid gland. It has skin lighting properties.
Use of Tyrosinase inhibitors to treat facial Melasma
Isobutylamido thiazolyl resorcinol interfere with the production of the melanin. It reduces the dark patches on the skin over the time. It has anti-inflammatory effects which can reduces the redness and irritation caused by melasma.
Effectiveness of Combination hydroquinone-free preparations to treat Melasma
Tranexamic acid: It reduces the activation of melanocytes, production of melanin and hyperpigmentation.
phenylethyl resorcinol: Phenylethyl resorcinol is a synthetic compound which is derived from resorcinol. It has depigmentation property. It inhibits the production of the melanin. It reduces the dark spots and hyperpigmentation linked with the melasma.
Effectiveness of Topical and intradermal tranexamic acid to treat Melasma
Topical Tranexamic Acid: Topical tranexamic acid is a non-invasive treatment option. It comes in the form of lotions, creams, and serums. It reduces the severity of melasma. It inhibits the melanin synthesis and prevent the transfer of melanin to keratinocytes. it can reduce the dark patches and make the skin even tone.
Intradermal Tranexamic Acid: Intradermal tranexamic acid is injected directly in the affected skin areas. The high concentration of tranexamic acid is injected on the hyperpigmented area which can lead to fast and more efficient results compared to topical treatment.
Effectiveness of oral agents to treat Melasma
Tranexamic Acid: Tranexamic acid is an antifibrinolytic agent which reduces the melasma. It inhibits the production of melanin and reduces the inflammations.
Polypodium Leucotomos Extract: This extract comes from a type of fern and has an antioxidant and photoprotective properties. It protects the skin from UV light and decrease the symptoms of melasma.
Glutathione: Oral glutathione helps to treat melasma along with other treatments like laser therapy and topical agents.
Use of chemical peels to treat Melasma
Glycolic acid:
Glycolic acid an effective chemical exfoliant. It breaks down the intercellular bonds of the dead skin cells. It removes the pigmented and damages skin cells and gives smooth and even skin tone and decreasing the melasma. It exfoliate the upper layer of skin and allows the skin care products like topical creams or serums to penetrate the skin and improve the effectiveness to treat melasma. It simulates the production of collagen and improves the skin texture and firmness. It reduces the appearance of melasma over the time.
Salicylic acid:
Salicylic acid is a lipophilic agent which is used for superficial peeling. About 20 to 30% of salicylic acid is effective to treat melasma.
Trichloroacetic acid:
TCA is an effective chemical peeling agent which exfoliate the outer layer of skin and reduces the hyperpigmentation and improve the skin texture.
Chemical Peels: Chemical peels are a cosmetic procedure in which chemical solution is applied on skin and remove the outer layer of skin. It increases the cell turnover and increases the even one skin. The intensity of the peel is adjusted in the basis of severity of the disease. Peeling agents like salicylic acid, glycolic acid and TCA is used in this procedure.
Microdermabrasion: It reduces the appearance of melasma by eliminating the outer layer of skin and gives a new skin growth.
Laser Therapy: Laser treatment like Q-switched lasers can target the pigmented area of the skin and disrupt the structure. It decreases the dark patches linked with the melasma.
Topical Depigmenting Agents: Topical treatments like hydroquinone, retinoids, azelaic acid, kojic acid, and vitamin C serums are used to manage melasma. They inhibit the production of melanin.
Assessment and Diagnosis: The 1st step is to assess and diagnose the disease by a dermatologist or healthcare provider. They will examine the skin and medical history of patient. Different types of melasma may have different treatment. Accurate diagnosis is necessary for effective management.
Management of melasma includes the sun protection, topical treatments, chemical peels, and laser and light therapies. Sun exposure leads to melasma. Patient must avoid the direct sunlight and use the SPF creams. Topical agents like hydroquinone, retinoids, azelaic acid, kojic acid, and vitamin C are used as 1st line treatment. Combination treatments like chemical peels can increase the effectiveness of treatment. Laser treatment like IPL and fractional laser can target the melanin and decrease the hyperpigmentation.
Melasma is a skin disease which causes dark, patchy and discolored skin surface. It mainly affects the face. It is also known as the mask of pregnancy. It occurs in females during the pregnancy. It also affects the men and people from all the ages and backgrounds. Melasma appears on the cheek, forehead, nose, upper lip and chin.
Melasma is more common in women. About 90% of the cases are seen in females. It also affects the men but in small %. The rate differs from different population and geographic area. It can occur at any age. It appears during the reproductive years mainly in the age pf 20 to 40 years.
Melasma is more common in U.S. about affect over 5 million people. The prevalence rate is about 8.8% in females of Latino which are living in the southern U.S., 13.4 to 15.5 % in Arab Americans in the Michigan and 40% in south-east Asia.
Melasma can occur at any race of people. It is more common in the dark skin type than the light skin type, specifically in the light brown skin type. The ratio of female to male is about 9:1. About 15 to 50% of the pregnant women may have melasma. The prevalence rate may differ from 1.5 to 33 % on the basis of population.
Hormones play an important role in the development of the melasma. Any changes in the hormone can lead to this condition. Melasma is also known as hormone related or hormone dependent skin disease. UV radiation from the sun is a main factors which can develop melasma. Sun exposure can lead to elevated production of the melanin and lead to dark patches on the skin. People who are living in the areas with a high exposure to sun are at the high risk of this disease.
These is some research which indicate that the genetics may play a role in the melasma. If you have any history of melasma in the family, you are at the high risk of this condition.
The most common factor is sunlight exposure. UV radiation increases the production of α-melanocyte stimulating hormones and corticosteroid, IL-1 and endothelin 1. It can increases the production of melanin by the intraepidermal melanocytes. Continuous exposure to the UV light may lead to dermal inflammation and activation of fibroblast in the melasma dermis. This can cause elevated melanogenesis.
The main factor is the excessive production and accumulation of the melanin. Melanin is produces by the melanocytes. It is cells which are located at the basal layer of epidermis. An excessive activity of melanocytes can lead to over production of the melanin in melasma.
Sun exposure can lead to over production of melanin and causes DNA damage because of the UV radiation. It can cause dark patches.
Hormones like estrogen and progesterone may affect the activity of melanocytes and lead to stimulation of production of the melanin. Use of hormonal contraceptives, menopause, pregnancy, medications like birth control pills can affect the levels of hormones and lead to melasma.
UV radiation can stimulate the melanocytes and produce an excessive pigmentation and form the dark patches on skin. Sun exposure without proper protection may worse the existing melasma and elevate the risk of development of new patches.
Some studies have indicated that there is a link between thyroid dysfunction and the melasma. The exact process is not known but thyroid hormone may affect the production and distribution of the melanin in the skin.
Melasma is more common in dark skin type specifically Fitzpatrick skin type III to VI. Asian, Middle Eastern, African, and Hispanic are more prone to develop the melasma.
Melasma is not linked with mortality and morbidity. Patients who have melasma are at the low risk of developing the melanoma.
Melasma can occur on the area which is exposed to the sun as acquired hypermelanosis. It is a symmetrical distributed hyperpigmentation macules which are punctate. It gets worse if the area gets the excessive sun exposure like cheek, upper lip, chin and forehead.
Women whose age is 20 to 40 years are in the phase of pregnancy and linked with changes in the hormones or taking the contraceptives may get the disease. It is necessary to get the proper diagnosis and prognosis from the dermatologist if you have melasma or other skin disease.
The healthcare provider will take the detailed medical history about aby earlier skin diseases, medication, family history of melasma or any other skin disease or factors which can contribute to the condition.
The healthcare provider will assess the affected area of the skin like face, forehead, cheek, chin, upper lip, nose. The patches can have symmetrical distribution.
Dermatoscopy or dermoscopy is a non-invasive method which allows the healthcare provider to assess the surface of the skin by using magnifying tool dermatoscope. It assesses the pigmentation of the kin and structure which can be beneficial in the diagnosis.
Melasma mainly gradually increase over the time. The patched becomes more darker after the exposure to sun.
Hormonal changes: Melasma is often associated with hormonal fluctuations, particularly during pregnancy (chloasma or “mask of pregnancy”) or while taking hormonal contraceptives. Hormones like estrogen and progesterone can stimulate melanocytes (cells responsible for producing melanin), leading to increased pigmentation in susceptible individuals.
Sun exposure: Sunlight can stimulate melanin production, exacerbating the patches and making them more visible. Individuals with melasma must prioritize safeguarding their skin against the sun by employing broad-spectrum sunscreen, donning protective clothing, and steering clear of peak sun hours.
Family history: Melasma may have a genetic component, and individuals with a family history of the condition may be more prone to developing it themselves.
Thyroid disorders: There may be a link between melasma and thyroid dysfunction, although the exact mechanism is not fully understood.
Actinin Lichen Planus
Acanthosis Nigricans
Solar Lentigines
Post-inflammatory hyperpigmentation
Poikiloderma of Civatte
Ochronosis and Alkaptonuria
Nevi of Ota and Ito
Mastocytosis
Lichen Planus pignemtosus
Hori Neus
Frictional Melanosis
Fixed drug eruptions
Exogenous Ochronosis
Erythema Dyschromic Perstans
Drug induced photosensitivity
Contact dermatitis, pigmented
Sun Protection: The 1st step is to avoid sun exposure and protection from the sun to treat melasma. Patient can use broad spectrum sunscreen which has a high SPF sun protection factor like SPF 30 or 50 and reapply it in every 2 hours when exposed to the sunlight. Sun protective cloth, wide hats and sunglasses are suggested.
Topical Agents: Topical agents are the 1st line of treatment. It gives the light effect to the hyperpigmented area and decrease the production of melanin. The most common topical agents are:
Hydroquinone: It is a depigmented agent which inhibits the synthesis of melanin. It is available in different strengths. Long term usage must be monitored by the dermatologist because of the side effects.
Retinoids: Tretinoin is a topical retinoid which can help to increase the penetration of other agents and stimulates the skin cell turnover.
Azelaic Acid: It has both depigmentation and anti-inflammatory properties. It is sued as an alternative treatment or along with hydroquinone.
Kojic Acid, Vitamin C, and Licorice Extract: These are the natural skin lighting agents. It can be used as a topical agents to increase the results.
Chemical Peels: It is a cosmetic procedure which are administered on the outer layer of the skin. It exfoliates the skin and stimulate the regeneration of the fresh skin cells. Artificial and medium depth chemical peels like salicylic acid, glycolic acid or trichloroacetic acid (TCA) may treat the melasma by exfoliating pigmented areas.
Combination Therapy: Combination of the treatment can be more effective to manage melasma. A dermatologist creates a customized treatment plan which includes a combination of the topical agents, laser treatment and chemical peels to get the good results.
Dermatology, General
Sun protection: Melasma is often triggered or worsened by exposure to the sun’s ultraviolet (UV) rays. Use broad-spectrum sunscreen with a high SPF (30 or higher) daily, even on cloudy days. Reapply sunscreen every two hours, especially if you are outdoors. Additionally, wear wide-brimmed hats, sunglasses, and protective clothing to minimize sun exposure.
Avoid peak sun hours: Try to stay indoors or seek shade during peak sun hours, Usually, the period from 10 am to 4 pm experiences the most intense sunlight due to the sun’s powerful rays.
Minimize heat exposure: Prolonged exposure to heat can worsen melasma. Stay in cool environments and avoid hot showers or baths.
Gentle skincare products: Use mild and gentle skincare products that do not irritate the skin. Avoid harsh scrubs, exfoliants, or astringents that may worsen melasma.
Avoid hormone-triggering factors: Hormonal fluctuations, such as those occurring during pregnancy or with certain medications, can contribute to melasma. If you are on hormonal medications, discuss alternative options with your doctor.
Dermatology, General
Hydroquinone is widely used agent to treat melasma. It is a depigmented agent which inhibits the activity of melanocytes which can produce the melanin. It is available in different forms like gels, lotion, creams, and serum.
Dermatology, General
Hydroquinone: This acts as a skin lighting agent. It inhibits the production of melanin. It helps to decrease the dark patches and hyperpigmentation linked with the melasma.
Tretinoin (Retinoid): Tretinoin is a derivative of vitamin A. It increases the skin cell turnover and leads to the even skin tone and renewal of the skin.
Fluocinolone: Fluocinolone is a corticosteroid medication which is used in triple combination cream.
Dermatology, General
Azelaic acid
Azelaic acid decreases the synthesis of melanin. It plays an important role in the determination of skin color. Azelaic acid helps to light the hyperpigmented areas. It also has anti-inflammatory effects which reduces the inflammation linked with melasma. It removes the dead skin because of the mild exfoliating effects. Azelaic acid creams come in different concentrations like 15 % or 20%.
Kojic acid
Kojic acid inhibits the tyrosinase enzyme. It plays an important role in production of melanin. Kojic acid reduces the production of melanin and fades the dark spots and promotes even skin tone.
Kojic acid has antioxidant property. It contains free radical which can reduces the oxidative stress on the skin and prevent the darken effects on the patches.
Niacinamide
Niacinamide inhibits the conversation of melanin from melanocytes to keratinocytes. It prevents the excessive pigmentation and reduces the patches on the skin by reducing the transfer of melanin. It also has anti-inflammatory property. It smooths the skin and reduces the redness and irritation of the skin.
Rucinol
Rucinol inhibits the activity of tyrosine. Tyrosine converts the tyrosine in different forms of melanin. Rucinol reduces the production of melanin by inhibiting this enzymes in the skin cells. It leads to the lighting effects on the hyperpigmented area of the skin.
Cysteamine
Cysteamine interferes with the mechanism of production of melanin. It inhibits the activity of melanocytes and reduces the synthesis of melanin. It has antioxidant property. It neutralizes the free radicals in the skin and reduces the dark patches.
Undecylenoyl phenylalanine:
Undecylenoyl phenylalanine inhibits the activity of tyrosine. It reduces the production of melanin by inhibiting this enzymes in the skin cells. It leads to the lighting effects on the hyperpigmented area of the skin.
It also interferes with the transfer of melanin from melanocytes to keratinocytes and reduces the pigmentation on the affected areas.
Topical methimazoleÂ
Topical methimazole is mainly used to treat hyperthyroidism. Methimazole inhibits the production of thyroid hormones in the thyroid gland. It has skin lighting properties.
Dermatology, General
Isobutylamido thiazolyl resorcinol interfere with the production of the melanin. It reduces the dark patches on the skin over the time. It has anti-inflammatory effects which can reduces the redness and irritation caused by melasma.
Dermatology, General
Tranexamic acid: It reduces the activation of melanocytes, production of melanin and hyperpigmentation.
phenylethyl resorcinol: Phenylethyl resorcinol is a synthetic compound which is derived from resorcinol. It has depigmentation property. It inhibits the production of the melanin. It reduces the dark spots and hyperpigmentation linked with the melasma.
Dermatology, General
Topical Tranexamic Acid: Topical tranexamic acid is a non-invasive treatment option. It comes in the form of lotions, creams, and serums. It reduces the severity of melasma. It inhibits the melanin synthesis and prevent the transfer of melanin to keratinocytes. it can reduce the dark patches and make the skin even tone.
Intradermal Tranexamic Acid: Intradermal tranexamic acid is injected directly in the affected skin areas. The high concentration of tranexamic acid is injected on the hyperpigmented area which can lead to fast and more efficient results compared to topical treatment.
Dermatology, General
Tranexamic Acid: Tranexamic acid is an antifibrinolytic agent which reduces the melasma. It inhibits the production of melanin and reduces the inflammations.
Polypodium Leucotomos Extract: This extract comes from a type of fern and has an antioxidant and photoprotective properties. It protects the skin from UV light and decrease the symptoms of melasma.
Glutathione: Oral glutathione helps to treat melasma along with other treatments like laser therapy and topical agents.
Dermatology, General
Glycolic acid:
Glycolic acid an effective chemical exfoliant. It breaks down the intercellular bonds of the dead skin cells. It removes the pigmented and damages skin cells and gives smooth and even skin tone and decreasing the melasma. It exfoliate the upper layer of skin and allows the skin care products like topical creams or serums to penetrate the skin and improve the effectiveness to treat melasma. It simulates the production of collagen and improves the skin texture and firmness. It reduces the appearance of melasma over the time.
Salicylic acid:
Salicylic acid is a lipophilic agent which is used for superficial peeling. About 20 to 30% of salicylic acid is effective to treat melasma.
Trichloroacetic acid:
TCA is an effective chemical peeling agent which exfoliate the outer layer of skin and reduces the hyperpigmentation and improve the skin texture.
Melasma is a skin disease which causes dark, patchy and discolored skin surface. It mainly affects the face. It is also known as the mask of pregnancy. It occurs in females during the pregnancy. It also affects the men and people from all the ages and backgrounds. Melasma appears on the cheek, forehead, nose, upper lip and chin.
Melasma is more common in women. About 90% of the cases are seen in females. It also affects the men but in small %. The rate differs from different population and geographic area. It can occur at any age. It appears during the reproductive years mainly in the age pf 20 to 40 years.
Melasma is more common in U.S. about affect over 5 million people. The prevalence rate is about 8.8% in females of Latino which are living in the southern U.S., 13.4 to 15.5 % in Arab Americans in the Michigan and 40% in south-east Asia.
Melasma can occur at any race of people. It is more common in the dark skin type than the light skin type, specifically in the light brown skin type. The ratio of female to male is about 9:1. About 15 to 50% of the pregnant women may have melasma. The prevalence rate may differ from 1.5 to 33 % on the basis of population.
Hormones play an important role in the development of the melasma. Any changes in the hormone can lead to this condition. Melasma is also known as hormone related or hormone dependent skin disease. UV radiation from the sun is a main factors which can develop melasma. Sun exposure can lead to elevated production of the melanin and lead to dark patches on the skin. People who are living in the areas with a high exposure to sun are at the high risk of this disease.
These is some research which indicate that the genetics may play a role in the melasma. If you have any history of melasma in the family, you are at the high risk of this condition.
The most common factor is sunlight exposure. UV radiation increases the production of α-melanocyte stimulating hormones and corticosteroid, IL-1 and endothelin 1. It can increases the production of melanin by the intraepidermal melanocytes. Continuous exposure to the UV light may lead to dermal inflammation and activation of fibroblast in the melasma dermis. This can cause elevated melanogenesis.
The main factor is the excessive production and accumulation of the melanin. Melanin is produces by the melanocytes. It is cells which are located at the basal layer of epidermis. An excessive activity of melanocytes can lead to over production of the melanin in melasma.
Sun exposure can lead to over production of melanin and causes DNA damage because of the UV radiation. It can cause dark patches.
Hormones like estrogen and progesterone may affect the activity of melanocytes and lead to stimulation of production of the melanin. Use of hormonal contraceptives, menopause, pregnancy, medications like birth control pills can affect the levels of hormones and lead to melasma.
UV radiation can stimulate the melanocytes and produce an excessive pigmentation and form the dark patches on skin. Sun exposure without proper protection may worse the existing melasma and elevate the risk of development of new patches.
Some studies have indicated that there is a link between thyroid dysfunction and the melasma. The exact process is not known but thyroid hormone may affect the production and distribution of the melanin in the skin.
Melasma is more common in dark skin type specifically Fitzpatrick skin type III to VI. Asian, Middle Eastern, African, and Hispanic are more prone to develop the melasma.
Melasma is not linked with mortality and morbidity. Patients who have melasma are at the low risk of developing the melanoma.
Melasma can occur on the area which is exposed to the sun as acquired hypermelanosis. It is a symmetrical distributed hyperpigmentation macules which are punctate. It gets worse if the area gets the excessive sun exposure like cheek, upper lip, chin and forehead.
Women whose age is 20 to 40 years are in the phase of pregnancy and linked with changes in the hormones or taking the contraceptives may get the disease. It is necessary to get the proper diagnosis and prognosis from the dermatologist if you have melasma or other skin disease.
The healthcare provider will take the detailed medical history about aby earlier skin diseases, medication, family history of melasma or any other skin disease or factors which can contribute to the condition.
The healthcare provider will assess the affected area of the skin like face, forehead, cheek, chin, upper lip, nose. The patches can have symmetrical distribution.
Dermatoscopy or dermoscopy is a non-invasive method which allows the healthcare provider to assess the surface of the skin by using magnifying tool dermatoscope. It assesses the pigmentation of the kin and structure which can be beneficial in the diagnosis.
Melasma mainly gradually increase over the time. The patched becomes more darker after the exposure to sun.
Hormonal changes: Melasma is often associated with hormonal fluctuations, particularly during pregnancy (chloasma or “mask of pregnancy”) or while taking hormonal contraceptives. Hormones like estrogen and progesterone can stimulate melanocytes (cells responsible for producing melanin), leading to increased pigmentation in susceptible individuals.
Sun exposure: Sunlight can stimulate melanin production, exacerbating the patches and making them more visible. Individuals with melasma must prioritize safeguarding their skin against the sun by employing broad-spectrum sunscreen, donning protective clothing, and steering clear of peak sun hours.
Family history: Melasma may have a genetic component, and individuals with a family history of the condition may be more prone to developing it themselves.
Thyroid disorders: There may be a link between melasma and thyroid dysfunction, although the exact mechanism is not fully understood.
Actinin Lichen Planus
Acanthosis Nigricans
Solar Lentigines
Post-inflammatory hyperpigmentation
Poikiloderma of Civatte
Ochronosis and Alkaptonuria
Nevi of Ota and Ito
Mastocytosis
Lichen Planus pignemtosus
Hori Neus
Frictional Melanosis
Fixed drug eruptions
Exogenous Ochronosis
Erythema Dyschromic Perstans
Drug induced photosensitivity
Contact dermatitis, pigmented
Sun Protection: The 1st step is to avoid sun exposure and protection from the sun to treat melasma. Patient can use broad spectrum sunscreen which has a high SPF sun protection factor like SPF 30 or 50 and reapply it in every 2 hours when exposed to the sunlight. Sun protective cloth, wide hats and sunglasses are suggested.
Topical Agents: Topical agents are the 1st line of treatment. It gives the light effect to the hyperpigmented area and decrease the production of melanin. The most common topical agents are:
Hydroquinone: It is a depigmented agent which inhibits the synthesis of melanin. It is available in different strengths. Long term usage must be monitored by the dermatologist because of the side effects.
Retinoids: Tretinoin is a topical retinoid which can help to increase the penetration of other agents and stimulates the skin cell turnover.
Azelaic Acid: It has both depigmentation and anti-inflammatory properties. It is sued as an alternative treatment or along with hydroquinone.
Kojic Acid, Vitamin C, and Licorice Extract: These are the natural skin lighting agents. It can be used as a topical agents to increase the results.
Chemical Peels: It is a cosmetic procedure which are administered on the outer layer of the skin. It exfoliates the skin and stimulate the regeneration of the fresh skin cells. Artificial and medium depth chemical peels like salicylic acid, glycolic acid or trichloroacetic acid (TCA) may treat the melasma by exfoliating pigmented areas.
Combination Therapy: Combination of the treatment can be more effective to manage melasma. A dermatologist creates a customized treatment plan which includes a combination of the topical agents, laser treatment and chemical peels to get the good results.
Dermatology, General
Sun protection: Melasma is often triggered or worsened by exposure to the sun’s ultraviolet (UV) rays. Use broad-spectrum sunscreen with a high SPF (30 or higher) daily, even on cloudy days. Reapply sunscreen every two hours, especially if you are outdoors. Additionally, wear wide-brimmed hats, sunglasses, and protective clothing to minimize sun exposure.
Avoid peak sun hours: Try to stay indoors or seek shade during peak sun hours, Usually, the period from 10 am to 4 pm experiences the most intense sunlight due to the sun’s powerful rays.
Minimize heat exposure: Prolonged exposure to heat can worsen melasma. Stay in cool environments and avoid hot showers or baths.
Gentle skincare products: Use mild and gentle skincare products that do not irritate the skin. Avoid harsh scrubs, exfoliants, or astringents that may worsen melasma.
Avoid hormone-triggering factors: Hormonal fluctuations, such as those occurring during pregnancy or with certain medications, can contribute to melasma. If you are on hormonal medications, discuss alternative options with your doctor.
Dermatology, General
Hydroquinone is widely used agent to treat melasma. It is a depigmented agent which inhibits the activity of melanocytes which can produce the melanin. It is available in different forms like gels, lotion, creams, and serum.
Dermatology, General
Hydroquinone: This acts as a skin lighting agent. It inhibits the production of melanin. It helps to decrease the dark patches and hyperpigmentation linked with the melasma.
Tretinoin (Retinoid): Tretinoin is a derivative of vitamin A. It increases the skin cell turnover and leads to the even skin tone and renewal of the skin.
Fluocinolone: Fluocinolone is a corticosteroid medication which is used in triple combination cream.
Dermatology, General
Azelaic acid
Azelaic acid decreases the synthesis of melanin. It plays an important role in the determination of skin color. Azelaic acid helps to light the hyperpigmented areas. It also has anti-inflammatory effects which reduces the inflammation linked with melasma. It removes the dead skin because of the mild exfoliating effects. Azelaic acid creams come in different concentrations like 15 % or 20%.
Kojic acid
Kojic acid inhibits the tyrosinase enzyme. It plays an important role in production of melanin. Kojic acid reduces the production of melanin and fades the dark spots and promotes even skin tone.
Kojic acid has antioxidant property. It contains free radical which can reduces the oxidative stress on the skin and prevent the darken effects on the patches.
Niacinamide
Niacinamide inhibits the conversation of melanin from melanocytes to keratinocytes. It prevents the excessive pigmentation and reduces the patches on the skin by reducing the transfer of melanin. It also has anti-inflammatory property. It smooths the skin and reduces the redness and irritation of the skin.
Rucinol
Rucinol inhibits the activity of tyrosine. Tyrosine converts the tyrosine in different forms of melanin. Rucinol reduces the production of melanin by inhibiting this enzymes in the skin cells. It leads to the lighting effects on the hyperpigmented area of the skin.
Cysteamine
Cysteamine interferes with the mechanism of production of melanin. It inhibits the activity of melanocytes and reduces the synthesis of melanin. It has antioxidant property. It neutralizes the free radicals in the skin and reduces the dark patches.
Undecylenoyl phenylalanine:
Undecylenoyl phenylalanine inhibits the activity of tyrosine. It reduces the production of melanin by inhibiting this enzymes in the skin cells. It leads to the lighting effects on the hyperpigmented area of the skin.
It also interferes with the transfer of melanin from melanocytes to keratinocytes and reduces the pigmentation on the affected areas.
Topical methimazoleÂ
Topical methimazole is mainly used to treat hyperthyroidism. Methimazole inhibits the production of thyroid hormones in the thyroid gland. It has skin lighting properties.
Dermatology, General
Isobutylamido thiazolyl resorcinol interfere with the production of the melanin. It reduces the dark patches on the skin over the time. It has anti-inflammatory effects which can reduces the redness and irritation caused by melasma.
Dermatology, General
Tranexamic acid: It reduces the activation of melanocytes, production of melanin and hyperpigmentation.
phenylethyl resorcinol: Phenylethyl resorcinol is a synthetic compound which is derived from resorcinol. It has depigmentation property. It inhibits the production of the melanin. It reduces the dark spots and hyperpigmentation linked with the melasma.
Dermatology, General
Topical Tranexamic Acid: Topical tranexamic acid is a non-invasive treatment option. It comes in the form of lotions, creams, and serums. It reduces the severity of melasma. It inhibits the melanin synthesis and prevent the transfer of melanin to keratinocytes. it can reduce the dark patches and make the skin even tone.
Intradermal Tranexamic Acid: Intradermal tranexamic acid is injected directly in the affected skin areas. The high concentration of tranexamic acid is injected on the hyperpigmented area which can lead to fast and more efficient results compared to topical treatment.
Dermatology, General
Tranexamic Acid: Tranexamic acid is an antifibrinolytic agent which reduces the melasma. It inhibits the production of melanin and reduces the inflammations.
Polypodium Leucotomos Extract: This extract comes from a type of fern and has an antioxidant and photoprotective properties. It protects the skin from UV light and decrease the symptoms of melasma.
Glutathione: Oral glutathione helps to treat melasma along with other treatments like laser therapy and topical agents.
Dermatology, General
Glycolic acid:
Glycolic acid an effective chemical exfoliant. It breaks down the intercellular bonds of the dead skin cells. It removes the pigmented and damages skin cells and gives smooth and even skin tone and decreasing the melasma. It exfoliate the upper layer of skin and allows the skin care products like topical creams or serums to penetrate the skin and improve the effectiveness to treat melasma. It simulates the production of collagen and improves the skin texture and firmness. It reduces the appearance of melasma over the time.
Salicylic acid:
Salicylic acid is a lipophilic agent which is used for superficial peeling. About 20 to 30% of salicylic acid is effective to treat melasma.
Trichloroacetic acid:
TCA is an effective chemical peeling agent which exfoliate the outer layer of skin and reduces the hyperpigmentation and improve the skin texture.
Dermatology, General
Chemical Peels: Chemical peels are a cosmetic procedure in which chemical solution is applied on skin and remove the outer layer of skin. It increases the cell turnover and increases the even one skin. The intensity of the peel is adjusted in the basis of severity of the disease. Peeling agents like salicylic acid, glycolic acid and TCA is used in this procedure.
Microdermabrasion: It reduces the appearance of melasma by eliminating the outer layer of skin and gives a new skin growth.
Laser Therapy: Laser treatment like Q-switched lasers can target the pigmented area of the skin and disrupt the structure. It decreases the dark patches linked with the melasma.
Topical Depigmenting Agents: Topical treatments like hydroquinone, retinoids, azelaic acid, kojic acid, and vitamin C serums are used to manage melasma. They inhibit the production of melanin.
Dermatology, General
Assessment and Diagnosis: The 1st step is to assess and diagnose the disease by a dermatologist or healthcare provider. They will examine the skin and medical history of patient. Different types of melasma may have different treatment. Accurate diagnosis is necessary for effective management.
Management of melasma includes the sun protection, topical treatments, chemical peels, and laser and light therapies. Sun exposure leads to melasma. Patient must avoid the direct sunlight and use the SPF creams. Topical agents like hydroquinone, retinoids, azelaic acid, kojic acid, and vitamin C are used as 1st line treatment. Combination treatments like chemical peels can increase the effectiveness of treatment. Laser treatment like IPL and fractional laser can target the melanin and decrease the hyperpigmentation.
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