Melasma/Hyperpigmentation

An even complexion is always desired.  Most don’t realize that effects of daily sun exposure.  Regular sunscreen use can help to prevent unwanted discoloration from even occurring.  Just remember 90% of all wrinkles, age spots and skin discoloration is due to sun and tanning bed exposure.

Hyperpigmentation is an abnormal darkening on the skin. The cells responsible for hyperpigmentation are located in the top layer of the skin and are called melanocytes.  Melanocytes produce a chemical compound called melanin by the action of an enzyme called tyrosinase.  Melanin is what makes the skin tan on exposure to the sun. 

Over time increased melanin may cause irregular dark spots on the face, back, arms, hands, and legs. 
Common conditions that cause hyperpigmentation are:

  • Sun damage - one of the main causes of hyperpigmentation and will darken already hyperpigmented areas, as well as give rise to lentigines and keratoses, also known as age spots, sun spots, liver spots and freckles.
  • Post inflammatory hyperpigmentation - increase of pigmentation seen in the skin after an injury or inflammation to the skin such as a rash, acne breakouts, scratching, bruising, surgical and/or laser procedures. 
  • Melasma - darkening of the facial skin, due to a combination of risk factors such as family history, hormones, pregnancy, skin type, and sun exposure.
  • Medications, such as amiodarone, minocycline, tetracycline, bleomycin, cyclophosphamide, antimalarials and others.
  • Pregnancy
  • Systemic diseases, such as Addison’s disease, Cushing’s disease, hemochromatosis, porphyrias and many others.  These diseases tend to produce diffuse, generalized hyperpigmentation.

 

Melasma

 

What is melasma?

Melasma is a common skin condition that causes tan to gray-brown patches on the face and develops mainly in women. It affects people of all ethnic groups, but particularly those with Fitzpatrick skin types IV–VI (See the Skin Typing Chart).  It is also known as chloasma or mask of pregnancy.

Melasma usually forms on the cheeks, bridge of the nose, forehead, chin, and upper lip, and occasionally on the forearms and neck.  It may develop during pregnancy, while taking birth control pills or during menopause.  Sometimes it appears for no obvious reason.

Who gets melasma?

Most melasma occurs in women in their reproductive years. Only 10 percent of those affected are men. It generally starts between the age of 30 and 40.

It is more common in people that tan well or have naturally dark skin compared with those who have fair skin, particularly if they live in a sunny area.  It is often seen in Asia, the Middle East, South America, Africa and the Indian subcontinent.

What does melasma look like?

Tan or brown spots are seen mainly on the cheeks, jaw, forehead, nose, chin, and above the upper lip.

 

 

Photos courtesy of Dermquest.com and the Global Skin Atlas

Melasma is sometimes separated into epidermal (skin surface), dermal (deeper) and mixed types. The dermal and mixed types are significantly more difficult to treat than the superficial form of melisma.  The type of melasma can be diagnosed clinically with the help of a Wood’s Lamp or a skin biopsy may be necessary to determine the depth of the disorder.

 

Type of melasma

Clinical features

Epidermal

  • Well-defined border
  • Dark brown color
  • Appears more obvious under Wood’s Lamp
  • Responds well to treatment

Dermal

  • Ill-defined border
  • Light brown or brown-gray color
  • Unchanged under Wood’s Lamp
  • Responds poorly to treatment

Mixed

  • Combination of light and brown patches
  • Partial improvement with treatment

 

What causes melasma?

What causes melasma is still unknown. People with a family history of melasma are more likely to develop this skin condition.

The two most common triggers for melasma are sun exposure and an increase in female hormones estrogen and progesterone, such as during pregnancy or while taking birth control pills or hormone replacement therapy.

Other triggers include cosmetics, photOTOXic drugs (make the skin more susceptible to light damage), anti-seizure medications.

Treatments for melasma offered at Summit Medical Group

Sometimes melasma fades on its own. This is especially true after a pregnancy or when a woman stops taking birth control pills. If the melasma does not gradually fade or a woman wants to continue taking birth control pills, melasma can be treated. 

Treating melasma often requires a comprehensive approach:

  • Avoiding the sun and using a broad-spectrum sunscreen are key to preventing melasma. This is essential because even when it is cloudy outside, the sun's UV rays can penetrate the skin.  Sunscreen also must be worn when most of the day will be spent indoors because even a brief walk, driving, or sitting next to a window can expose unprotected skin to enough sunlight to trigger melasma. Continuing to wear sunscreen every day after the melasma clears can prevent it from returning.  Without the strict avoidance of sunlight, successful treatments for melasma are doomed to failure.
  • Topical medications containing hydroquinone, a commonly used skin-lightening agent.  Over-the-counter skin lightening preparations usually contain 2% hydroquinone.  Prescription fading creams contain 4% hydroquinone, sometimes in combination with sunscreen, retinoids and glycolic acid.
  • One of the best topical medications for moderate to severe melasma is Tri-Luma ®, a combination of hydroquinone, tretinoin and fluocinolone.
  • Creams containing tretinoin, kojic acid, and azelaic acid, singularly or in combination, have been shown to improve the appearance of melasma.
  • Chemical peels and MicroLaserPeels work well for superficial (epidermal) melasma.
  • Fractional erbium skin resurfacing (ProFractional) has been shown to work for the deeper and mixed forms of melasma.
  • At Summit Medical Group Dermatology, we careful tailor the treatments to the patient's skin type, which both improves the outcome and helps avoid complications.
  • Similar therapies are used clinically to treat post inflammatory hyperpigmentation. For all therapies sunscreen use and UV avoidance is important.

To schedule an appointment with Dr. Altman, please call Summit Medical Group Dermatology at (908) 277-8668.

Summit Medical Group provides medical, surgical, and cosmetic dermatology for women, men, and adolescents in the tri-state area, including New York and New Jersey as well as Essex County, Morris County, Bergen County, Union County, Passaic County, Somerset County, Sussex County, and Livingston, NJ; Millburn, NJ; Short Hills, NJ; West Orange, NJ; Berkeley Heights, NJ; Caldwell, NJ; Cedar Grove, NJ; Cedar Knolls, NJ; Chatham, NJ; East Hanover, NJ; Englewood Cliffs, NJ; Essex Fells, NJ; Fair Lawn, NJ; Florham Park, NJ; Fort Lee, NJ; Glen Ridge, NJ; Jersey City, NJ; Kennelon, NJ; Madison, NJ; Maplewood, NJ; Mendham, NJ; Montclair, NJ; Montvale, NJ; Morristown, NJ; New Providence, NJ; North Caldwell, NJ; Parsippany, NJ; Randolph, NJ; Roseland, NJ; South Orange, NJ; Springfield, NJ; Summit, NJ; Union, NJ; Verona, NJ; West Caldwell, NJ; Whippany, NJ; and Westfield, NJ.

 

Melasma/Brown Spots/Freckles/Hyperpigmentation

 

 

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