Melasma is the term given to hormone-induced extra pigmentation in the skin which most commonly looks brownish or even a bit grey. Melasma usually becomes more noticeable in the summer and improves during the winter months.
While the exact cause is not known, it is thought to be because of pigment-producing cells in the skin (melanocytes) producing too much pigment (melanin). This can be as a result of hormonal fluctuations, so it’s quite common when taking the oral contraceptive pill (the ‘Pill’).
It can also happen during pregnancy when it is called chloasma or pregnancy mask. This can affect up to 50% of pregnant women to one degree or another.
Rarely, other medical problems that affect hormones (such as thyroid problems) may cause melasma, as well as some other medications, such as anti-epileptics. If in doubt — ask your doctor.
Exposure to ultraviolet (UV) light from the sun and the use of sunbeds or phototherapy can trigger melasma or make it worse. Most of us are now aware of the huge risks involved in sunbed use — not just for pigmentation problems and skin cancer but also for premature ageing of the skin.
At the moment there is no cure as such for melasma, but there are several treatment options that can improve the appearance of it. If melasma occurs during pregnancy, it may go away a few months after delivery and treatment may not be necessary- though it may come back during another pregnancy or if taking the contraceptive pill. Hydroquinone and retinoid creams should be avoided in pregnancy as they could harm the foetus. Even if it is treated, melasma often returns after stopping the treatments.
Melasma treatments fall into several distinct categories but they can be used in conjunction with each other:
One key thing to remember with melasma is that treating it earlier is better as it is easier to tackle when it is new. There are lots of options out there now to help with this condition but always do your research and get expert advice.
More information can be found from the British Association of Dermatologists information sheet on melasma.
Written by Dr James Dean – Dermatology Doctor at Freyja Medical, Wrexham