Is Melasma curable? Causes of Melasma and how to treat it 

Skin hyperpigmentation has been a pain point for both men and women. Various factors can aggravate the melanocytes or the skin's pigment-producing cells and induce them to produce an increased amount of melanin. One of such undesirable consequences of melanin overdrive is melasma.

In this article, we have tried to throw light on one of the most commonly found forms of hyperpigmentation: Melasma. Keep reading to find out what can cause melasma and what you can do to treat it. 

What is melasma?

Melasma is a commonly acquired skin disorder that presents itself as hyperpigmented spots and patches, usually brown or grey, that appear randomly on the skin. They are symmetrical discolorations that usually develop on the face. They might appear on the nose's bridge, the forehead, cheeks, and the upper lips. Melasma can appear on other parts of the body, like the forearms, shoulder, and neck.

Melasma can be found in both males and females. However, it is more prevalent in the female population. According to a survey done by the American Academy of Dermatologists, it was found that only about 10% of all cases of melasma occur in males. It is more common in individuals with darker skin complexion. Melasma also occurs in pregnant women, which is then termed chloasma. 

Did You Know?

Melasma is known to have a distinct female predominance. Epidemiological studies have found that the female to male ratio for occurrence of this skin disorder is 9:1. However, in another large, multicentre study done on 953 melasma patients in Brazil, the ratio was as high as 39:1. In a different study done n the Indian population with Melasma consisting of 312 patients, the female to male ratio was much lower, i.e., 4:1.  

Symptoms of Melasma: How Should You Identify? 

Melasma can be primarily identified as mottled grey or brown discolored patches on the skin. As mentioned earlier, these dark-colored patches commonly develop on the cheeks, forehead, bridge of the nose, above the upper lips, and the chin. Some people might also present similar patches on their neck and forearms.

Though these discolored patches on the skin do not harm the skin's health, they can be mentally distressing for certain individuals. Undesirable marks on the facial area can lower one's self-esteem and make one feel unworthy. Thus, people actively seek remedies to rectify such skin conditions.  

What Causes Melasma to Develop? 

As Dr. Kourosh says,

Melasma can result from a lot of different factors. Among those, the two of the most common causes of melasma are hormonal changes and sun exposure.  

Keep reading to get an idea about how these factors can induce the development of Melasma: 

• Hormones: Hormonal imbalance, usually during pregnancy, can cause Melasma. The fluctuation of hormones can also occur while under hormonal medications. Contraception pills or hormone replacement therapy are two such conditions that can give rise to melasma. 
  
• Sun Exposure: Exposure to the sun is another factor that can trigger the development of melasma. The harmful ultraviolet rays can affect the melanocytes or the pigment-producing cells of the skin and cause melasma. Not only that, even visible light or heat can exacerbate the development of melasma.  
  
• Other Factors: Melasma can be genetically induced too. Anyone having a blood relation with an individual having melasma is at risk of developing melasma. 
  

Did You Know?

Ethnicity plays a critical role in the development of Melasma. According to Melasma's various studies, it is found that Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, or people of Mediterranean descent are more likely to get Melasma.  

Diagnosis of Melasma: 

Melasma can be diagnosed clinically by looking for symmetrical hyperpigmented patches with irregular borders on the skin. According to studies, it has been found that 50-80% of melasma cases are of dentofacial pattern, which affects the forehead, nose, upper lip, excluding the philtrum, cheeks, and chin.

The malar pattern of Melasma generally affects the malar cheeks on the face, whereas the mandibular type of melasma appears on the chin and the jawline. Another newer melasma pattern can be diagnosed on non-facial body parts such as the neck, sternum, forearms, and upper extremities.

To know how deeply the Melasma has penetrated the skin layers, a dermatologist might diagnose the lesions under a device known as the Wood's light. However, many other skin disorders can be confused with Melasma, scientifically termed the differential diagnosis for melasma.  

Such disorders have a similar appearance as melasma. For instance, 

• Lichen planus pigments 
  
• Discoid lupus erythematosus 
  
• Phototoxic dermatitis
  
• Pigmented Contact Dermatitis 
  
• Drug-Induced pigmentation 
  
• Poikiloderma of Civatte 
  
• Erythromelanosis follicularis faciei 
  
• Ochronosis 
  
• Hori's nevus 
  
• Argyria 
  
• Nevus of Ota 
  
• Lentigines 
  
• Ephelides 
  
• Macular Amyloidosis 
  
• Post Inflammatory Hyperpigmentation.  
  

A skin biopsy must be performed to rule out Melasma's possibility with other similar skin disorders. A small bit of the skin is removed from the affected area and tested to confirm the lesion as Melasma. 

Can Melasma be Treated?

Melasma can fade away on its own if the intake of hormone-regulating medicines causes it. But that does not always happen, especially when it is caused due to genetic disposition or sun exposure. That's when external help is required. Keep reading to explore the various methods that can help in reducing the symptoms of melasma.  

Stay away from the sun. 

Before discussing the ways of treating Melasma, it is important to keep in mind that while the sun is important for sustaining all life, UV rays can be hazardous for your skin. Exposure to the UV rays can exacerbate the melanin-producing cells more if you already have symptoms of melanoma. Thus, keeping your skin safe from the sun is the first rule you have to follow.  

How can a professional help you?  

It is advised that you should consult with your dermatologist if you experience symptoms of Melasma. They would be able to diagnose the disorder properly and recommend the treatment suitable for you.  

These are some treatments that can help with melasma: 

1. Aloe Vera 

A study done in 2017 demonstrated that liposome-encapsulated aloe vera preparations could help improve the symptoms of Melasma in pregnant women. 

2. Polypodium leucotomos 

Polypodium leucotomos is a fern that originates from Central and South America. It is also known as Kalawalla, heliocare, Caligula, and anapsos. According to literature reviewed in 2014, it was found that orally administered preparation of Polypodium leucotomos can treat Melasma. However, more scientific study is required to support the claim. 

3. Tranexamic Acid 

Another literature reviewed in 2018 revealed that Tranexamic acid could be a promising oral remedy for treating Melasma. Derived from Lysine, which is an amino acid, Tranexamic acid is synthetic. It inhibits the plasminogen activation pathway. This, in turn, mitigates the UV-radiation induced pigmentation response in the skin.  

4. Glutathione 

It is an antioxidant made up of three amino acids: cysteine, glutamic acid, and glycine. The 2017 literature review also found that orally administered glutathione can reduce the melanin synthesis in patients with melasma compared to patients administered with placebo. 

5. Hydroquinone:  

Hydroquinone is one of the most commonly used ingredients for treating skin. It is available/accessible as an over-the-counter medicine in the form of lotions, gels, and ointments. When topically applied on the affected hyperpigmented area, hydroquinone bleaches the skin and fades away the discolored patch. 

6. Corticosteroids: 

Topical corticosteroids, like hydrocortisone, can help in fading skin hyperpigmentation. When applied regularly as gel or lotion directly on the Melasma-affected areas of the skin, the melasma can fade away within two to four months. 

7. Triple Cream 

Triple cream is a combination of three potent ingredients: corticosteroids, tretinoin, and hydroquinone. This combination can be very useful in reducing the symptoms of Melasma.  

8. Azelaic Acid 

The sources of Azelaic acid are interestingly, grains. Grains like Barley, rye, and wheat. This ingredient has the property to reduce the count of melanocytes. A pilot study conducted in 2011 demonstrated that Azelaic acid could lighten the darkened skin patches and spots, which is a great remedy for Melasma.

9. Kojic Acid 

Kojic acid is an ingredient that is extracted from different types of fungi. This ingredient inhibits tyrosine formation, which is an amino acid responsible for melanin synthesis. Topically applied kojic acid can reduce the melanin in the skin and eventually fade away the melasma patches. 

10. Chemical peels 

Chemical peeling is a cosmetic procedure that helps in removing damaged skin cells. Chemical solutions, usually of acidic nature, are applied on the skin, which causes the superficial skin cells to exfoliate and eventually peel off and reveal the healthier, lighter skin layer underneath.  

11. Dermabrasion 

Dermabrasion is a cosmetic procedure where the skin is exfoliated by using a rotating instrument, and the lighter, healthier skin cells are revealed. Dermabrasion can smoothen the skin and lighten the melasma affected skin. The discolored patches of melasma will gradually get erased with few sittings of this in-office procedure.   

12. Laser Treatment 

Laser therapies are medical treatments where the skin is exposed to a strong light source tuned to a specific wavelength. This intense light shrinks the melanin-producing cells, minimizes the melanin concentration, and fades away the melasma patches. 

13. Microneedling 

Micro-needling, also known as collagen-induced therapy or derma rolling, is a cosmetic procedure where tiny, sterile needles are used to puncture the skin. It is minimally invasive and considered safe. This procedure effectively lightens the discolored patches on the skin and is now considered one of the best ways to treat recalcitrant melasma.  

The Bottom Line: 

The gray or brown patches that mostly appear on the face are Melasma. However, it is recommended to visit your dermatologist to diagnose the disorder correctly and advise you on the ideal treatment. Hydroquinone is the most sought after treatment option. However, various other treatment options are now available for treating Melasma.