Melasma is also known as chloasma or the mask of pregnancy. It is not a harmful disease, but can severely affect a person’s cosmetic appearance. In this acquired condition, the skin on the face and neck slowly develops brown patches. Melasma is more common in women then men, and usually occurs during the second or third trimester of pregnancy. It may also develop in persons taking oral contraceptives, hormone replacement therapy, or excessive sun exposure.
The brown patches are attributed to an increased amount of pigment in the skin. The pigment may be located superficially in the epidermis (epidermal melasma), deeply in the dermis (dermal melasma), or a combination of both. The location of the pigment has important treatment considerations, and a dermatologist is skilled at making this determination.
Melasma associated with pregnancy usually fades slowly after delivery. Similarly, the pigmentation usually fades slowly after discontinuation of oral contraceptives. Darkening will most likely reoccur with subsequent pregnancies or reintroduction of oral contraceptives.
Fortunately, there are some very effective treatments that will help even the skin tone more rapidly. First and foremost, exposure to the ultraviolet light (sunlight and tanning booths) must be minimized. Sunscreens or sunblocks must be used. Depigmenting agents also known as "bleaching” creams are available over the counter as well as by prescription. The agent most commonly used is hydroquinone. This ingredient may also be combined with other agents such as tretinoin and glycolic acid to increase the efficacy of the medication. The skin may be sensitive to these medications and should be slowly and carefully introduced. The depigmenting effect is slow and will occur over several months.
Aside from or in addition to the depigmenting creams, a dermatologist may employ other techniques. Chemical peels, microdermabrasion, and even some lasers can be effective treatments.
One should keep in mind two very important points when it comes to the treatment of melasma. One, treatment is a slow process usually taking several months or more. Two, treatment results depend on the depth of the pigmentation. Treatment for epidermal melasma is much more successful then dermal melisma.
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