Melasma

Melasma is a skin pigmentation disorder characterized by the appearance of brown spots on the face of adult individuals. The cheeks, nasal septum, forehead, and upper lip are commonly affected, although some patients may experience milder symptoms in specific areas. This condition is particularly prevalent among people with dark skin, and it is observed in approximately 90% of women with colored skin. Melasma is often associated with changes in hormonal status, especially during pregnancy and with the use of birth control pills, earning it the nickname "mask of pregnancy." However, menopausal hormone replacement therapy has not been shown to cause melasma.

Exposure to sunlight is a primary trigger for facial blemishes, as ultraviolet and visible light stimulate pigment-producing cells called melanocytes to produce more pigments. Melanocytes are highly active in individuals with black or brown skin, and even minimal light exposure, such as driving in a car or walking in bright areas, can trigger melasma and contribute to its persistent nature.

Irritation of the skin can also lead to brown discoloration during the healing process, exacerbating the condition in individuals with melasma. Despite causing cosmetic concerns with the presence of multiple brown spots on the skin, melasma is confined to the face and is not associated with any internal disease or organ dysfunction.

The typical signs of melasma include patches of discolored skin on the forehead and face, varying in color from light brown to dark brown depending on the individual's skin type. These brown spots are evenly distributed on sun-exposed areas of the face, and pregnant women may develop a condition known as "pregnancy mask," characterized by butterfly-shaped brown spots on the face, arms, and neck. In most cases, melasma is harmless, with cosmetic issues being the primary concern. Pigmentation usually fades after pregnancy or the discontinuation of hormone therapy, although in a minority of cases, the spots may persist.

Melasma primarily affects the cheeks, nose, chin, upper lip, and forehead but can also appear on the arms, neck, and back—especially in sun-exposed areas, leading to an increase in symptoms during the summer months.

The prevalence of melasma is significant, with 15% to 50% of pregnant women being affected. Additionally, between 1.5% to 33% of individuals may experience melasma, most commonly during pregnancy and rarely during puberty. Women between the ages of 20 and 40 years are particularly susceptible to this skin disorder.

The causes of melasma can be classified into two main categories: radiation (including ultraviolet, visible, and infrared light) and hormones. Ultraviolet and infrared rays from the sun contribute to the exacerbation of melasma. Other factors such as anticonvulsant drugs, oral contraceptives containing estrogen and progesterone, genetics, hypothyroidism, LED lights, and hormonal changes during pregnancy play a role in causing melasma. While no specific foods are directly linked to the development or worsening of melasma, maintaining a healthy diet with vitamin-rich foods contributes to overall skin health.

Wood's lamp, emitting black light, can determine the depth of pigment penetration and classify melasma into three types: epidermal, dermal, and mixed melasma. Epidermal melasma appears as dark brown spots with a clear border, responding well to treatment. Dermal melasma presents with light brown or bluish spots and a pale border, while mixed melasma features a combination of blue and brown spots that partially respond to treatment.

Melasma is not cancerous and does not progress into cancerous cells over time. However, some skin cancers may resemble melasma, warranting evaluation by a dermatologist for an accurate diagnosis.

Diagnosis involves examining changes in the skin using Wood's lamp, and in some cases, a biopsy may be conducted to differentiate melasma from other skin conditions. Thyroid tests may also be recommended, as melasma has been associated with thyroid disease in some studies.

Overall, melasma is a common and manageable skin disorder, usually resolving within a few months or after the cessation of specific triggers like hormonal changes or pregnancy.