Melasma: a double answer
Do you have dark brown patches on your skin which developed in pregnancy or after starting on the pill? Does the colour darken after you have been in the sun? If so, you may be suffering from a condition called melasma.
Historically, there has been no cure for melasma. However, now there are treatments which can effectively fade unsightly discolouration, and even the skin tone.
Intense pulsed light (IPL) therapy works by breaking up melanin of the dark colour in the skin. Brown patches gradually disappear.
Another answer is to gently peel away the problem skin, layer by layer. Soon a bright new skin surface appears.
Both the light treatment and the peels work best in conjunction with a bleaching cream and good sun protection. With regular use of these products, melasma is not likely to recur.
Melasma is an acquired darkening of sun-exposed areas. The cheeks, the upper lip, the chin, and the forehead, are the most common locations, but it can occasionally occur in other sun-exposed places, too.
Chloasma is a synonymous term sometimes used to describe the occurrence of melasma during pregnancy.
The causes of melasma are uncertain. In many cases, a direct relationship with female hormonal activity appears to be present because it occurs with pregnancy and with the use of oral contraceptive pills.
Other factors may include photosensitising medications, mild ovarian or thyroid dysfunction, and certain cosmetics.
A genetic predisposition is also a major factor in the development of melasma. It is much more common in women than in men. More than 30% of patients have a family history of melasma.
The most important factor in the development of melasma is exposure to sunlight. Without keeping out of the sun, potentially successful treatments for melasma are not really likely to succeed.
Melasma is challenging to treat. The pigment of melasma develops gradually, and resolution is also gradual. Resistant cases or recurrences occur often, particularly if strict avoidance of sunlight is not rigidly heeded.
The mainstay of treatment remains topical depigmenting agents which are enhanced when used in conjunction with chemical peels and subsequent sun protection.