What is melasma?
Melasma, also called ‘chloasma’, is a common skin condition of adults in which light to dark brown or greyish pigmentation develops, mainly on the face. The name comes from melas, the Greek word for black. Although it can affect both genders and any race, it is more common in women and people with darker skin-types who live in sunny climates. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection, it is not contagious and it is not due to an allergy. Also, it is not cancerous and will not change into skin cancer.
What does melasma look like?
Melasma is simply darker-than-normal skin affecting the cheeks, forehead, upper lip, nose and chin, usually in a symmetrical manner. It may be limited to the cheeks and nose or just occur overlying the jaw. The neck and, rarely, the forearms can also be affected. Areas of melasma are not raised.
WHAT CAUSES MELASMA?
The cause of melasma is complex. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes (epidermal melanosis) and/or deposited in the dermis (dermal melanosis, melanophages). There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people, melasma is a chronic disorder.
Known triggers for melasma include:
- Sun exposure and sun damage—this is the most important avoidable risk factor
- Pregnancy—in affected women, the pigment often fades a few months after delivery
- Hormone treatments—oral contraceptive pills containing estrogen and/or progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women
- Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries, and cosmetics—these may cause a phototoxic reaction that triggers melasma, which may then persist long-term
- Hypothyroidism (low levels of circulating thyroid hormone)
Melasma commonly arises in healthy, non-pregnant adults. Lifelong sun exposure causes deposition of pigment within the dermis and this often persists long-term.
Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes to produce more melanin.
Research is attempting to pinpoint the roles of stem cell, neural, vascular and local hormonal factors in promoting melanocyte activation.
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