Melasma is a common skin condition that affects females mostly. It is characterized by brown or brown to grey patches that appear in sun-exposed areas; like the top of the cheeks, the nose, the chin, the forehead, the upper lip, and the shoulders and upper arms.
Melasma is usually diagnosed clinically and with the use of a special light called the woods lamp.
Causes:
Genetics: Around 50% of cases have a family member that suffers from melasma. It affects females much more commonly than males, especially females who have light skin color and who live in sunny areas and spend time in the sun.
Exposure to UV radiation (UV light, infrared light, and visible light) causes an increase in the production of melanin and therefore causes melasma.
Hormonal factors: the most important of which is pregnancy. Melasma affects around 15 to 50% of females during pregnancy; which is why it’s called “the mask of pregnancy”. In addition to oral contraceptives, hormonal IUDs, and thyroid issues.
Certain medications like some anti-epileptic drugs, some diuretics, some antibiotics, etc.
Treatment
The choice of treatment depends on the case and can be one or more of the following:
Avoid sun exposure, wear sunscreen with an SPF of 50 every day, and wear a wide-brimmed hat when the patient has to be in the sun
In the case where there is a temporary cause for the melasma; for example in pregnant women or those who are taking hormonal treatments, the melasma usually gets better if the cause is treated.
Topical treatments:
Hydroquinone either alone or in combination with tretinoins and steroids. This should only be used under medical supervision.
Creams that have active ingredients for lightening the skin like kojic acid, azelaic acid, alpha arbutin, vitamin c, niacinamide, and other options.
Chemical peels like salicylic acid, glycolic acid peels, and other kinds.
Laser and light therapy.
Injection of special ingredients to lighten the dark spots.
Microneedling.
Oral treatments like Tranexamic acid (only given under medical supervision because of possible dangerous side effects), and antioxidants like Glutathione.
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