Lots of people wish for fair, glowing, blemish-free skin. But due to environmental factors like pollution, sun exposure, and even dietary habits, skin can lose its glow and become exposed to various types of skin problems. Genetics also plays a major role in determining skin color and texture.

Pigmentation is strongly related to the health of a person's skin. One skin condition that is characterized by too much pigmentation is called melasma.

About Melasma

People with melasma suffer from dark brownish skin pigmentation on the sun-exposed regions of the face. This heavy pigmentation often occurs on the cheeks, forehead, chin, upper lips, and bridge of the nose; as well as on the neck or forearms. The condition is more frequently seen in females than in males, with only one out of every 20 melasma cases being reported in men. Melasma is especially common in pregnant women due to the many changes taking place in their bodies; in fact, it is sometimes referred to as "the mask of pregnancy."

The degree of skin discoloration in melasma patients varies from dark brown to deep grey. Though melasma can strike any ethnic group, it is prominently seen in Asians, Hispanics, Arabs, and Africans - all of whom have high levels of melanin (the pigment responsible for skin color) in their skin. In addition, melasma is often seen in people who live in tropical climates and spend lots of time in the sun.

The exact cause of melasma is still not known. The extent to which a person's skin changes color is determined by melanocytes, which are the pigment-producing cells located in the skin. Sun exposure usually triggers the melanocytes to increase production of melanin, which can result in patchy, dark pigmentation on the skin.

Melasma is suspected to be closely associated with the female hormones progesterone and estrogen. Women who are pregnant, take oral contraceptives, undergo hormone replacement therapy (HRT), or are menopausal experience substantial imbalances in their hormone levels that can increase their skin pigmentation. Using scented or deodorant soaps, toiletries, and cosmetics can also facilitate the development of melasma because they can cause a phototoxic reaction (one which increases the susceptibility to light damage) in the skin. Genetics are also a significant factor in melasma formation.

Melasma does not cause any noteworthy symptoms other than the discoloration of facial skin. The dark brownish patches that appear are very often symmetrical on each side of the face. Sometimes, freckle-like spots called macules may accompany the increase in skin pigmentation. However, it is important to remember that melasma cannot progress into a more serious disease such as skin cancer.

Close observation of the skin discoloration is usually enough for a doctor to come to a conclusive diagnosis. Some may also use a Wood's lamp (which shines ultraviolet light onto a patient's skin) for clearer observation of the affected skin. Occasionally, a skin biopsy is taken to confirm melasma.

While identifying melasma in pregnant women is very simple, diagnosing it in men and non-pregnant women requires the physician to rule out drug-related skin reactions or other medical and environmental factors that could cause skin pigmentation. Most importantly, the doctor should figure out whether the pigmentation is superficially located (epidermal melasma) or has moved deeper into the dermis region of the skin (dermal melasma) in order to provide effective treatment.

When melasma develops due to pregnancy, oral contraceptives, or hormone replacement therapy, the pigmentation often fades away on its own after birth or when the medication regimen is halted. However, there are many treatment options for women who want to continue using their contraceptives or undergoing HRT.

• Creams: There are a wide variety of topical creams available to treat melasma. An active ingredient in these creams is hydroquinone, which is a skin lightening agent. Some prescription creams may combine hydroquinone with substances such as tretinoin, corticosteroids, or glycolic acid - all of which work to reduce the pigmentation in the skin. And creams containing azelaic acid & kojic acid can help inhibit melanocyte formation.
• Sunscreen: Along with medicated creams, the doctor may also encourage the use of sunscreen whenever the patient is about to go out in the sun. Sunscreens that provide broad-spectrum protection and have a sun protection factor (SPF) of 30 or more are strongly recommended. Applying sunscreen every day before exposing skin to the sun's rays is the only way to prevent sun-exposed pigmentation.
• Medical Procedures: Chemical skin peels, microdermabrasion, and laser surgery are sometimes used to treat melasma and reduce pigmentation. These procedures should be tailored to the patient's skin type, or they might result in complications such as increased pigmentation.

Often with these procedures, sustained and effective results are achieved only after several months of treatment. Therefore, it is vital for patients to follow all of the instructions given by the doctor in order to get the maximum benefit from these treatments. Any side effects like skin irritation or the recurrence of melasma should be reported to the doctor immediately.

Outlook
Many times, melasma will subside on its own, especially if a catalyst like pregnancy, contraception, or HRT is removed from the equation. However, long-term treatment and skin care may be required for the skin to return to its normal color. While it can be annoying or troublesome, melasma is not dangerous to a person's health and does not lead to more serious diseases or conditions.