All of us have, at some point, encountered individuals with unusual patches of dark discolouration on face, neck or other areas. We may even have experienced such a problem ourselves, in which case we will know more than most about hyperpigmentation conditions, and perhaps even the subject of our focus here – melasma.
At the cellular level, disorders of pigmentation are caused by the skin pigment, melanin, being produced in excess and breaching normal containment mechanisms in the skin structure. While these conditions do not pose a serious medical threat, they can have psychological impacts, and be understandably upsetting from the aesthetic point of view.
Melasma (also known as chloasma) is a particular form of hyperpigmentation disorder characterised by tan or brown patches occurring (most commonly) on the face, typically in a symmetrical pattern on the forehead, nose, cheeks, chin and upper lip. It presents more commonly in women than men, and in people with darker skin types. Thankfully, it is not painful.
Melasma is particularly common in pregnant women – according to the British Association of Dermatologists, up to 50% of pregnant women may be affected. For this reason, it has acquired its own informal description for this context: ‘the pregnancy mask’.
Hormonal fluctuations are among the key melasma causes, as seen by the link with pregnancy. Oral contraceptives, hormone therapies, menopause, other conditions affecting the hormones (such as thyroid problems), some medications (e.g. treatments for epilepsy) and even using the wrong cosmetics, have been associated with the condition.
Exposure to the sun (UV light) can trigger melasma or make a pre-existing condition worse. As a general rule, patients experience flare-ups in the summer, rather than winter, months.
There is also evidence to suggest that family history may be a risk factor, with some studies finding that over half of patients with melasma have a positive family history.
There is no substitute for an experienced eye when it comes to diagnosing melasma. In the case of dark patches on the face, as opposed to other areas of the body, a symmetrical pattern on either side may provide a helpful clue. A dermatologist is the best port of call for definitive assessment and diagnosis, and effective follow-up treatment.
Aside from identifying the condition by visual examination, the dermatologist may conduct an examination using a hand-held microscope known as a dermascope, with imaging capabilities. More sophisticated diagnostic techniques that may be deployed include digital imaging platforms, which can provide an instant, painless and accurate view beneath the surface of the skin, without the need for surgical biopsy.
Melasma can be challenging to treat, and what works for one patient may not work for another. While a cure may not always be possible, the condition can certainly be effectively managed. Often, the best treatment for melasma is a combination of approaches that will improve the appearance of affected skin.
A sure-fire recommendation, in every case, is to limit sun exposure. Melasma cannot be corrected or prevented without sun protection, and most dermatologists will advise regular application of sunscreen (SPF30 or higher) and wearing a hat when exposed to the sun.
Topical treatments, such as hydroquinone, corticosteroids and azelaic acid may be effective, and oral medications might also be prescribed. Phototherapy (lasers and light) can also be applied to excellent effect, under the supervision of an experienced practitioner.
Melasma in pregnancy often disappears soon after giving birth, but in some cases, especially where there is sun exposure, it may take many months to fade away.
Dr Haus, himself, has over 20 years’ experience of managing melasma and hyperpigmentation conditions, and an impressive track record of treatment success. Trained in Brazil, where there are many different tones and types of skin, as well as lots of sun, he has what might be considered the ideal professional pedigree for this particular condition.
Dr Haus Dermatology in Harley Street was the first clinic in the UK to offer patients ‘elos’ technology, a state-of-the-art platform that delivers laser, light and radio frequencies to treat melasma and other hyperpigmentation conditions. Other melasma laser treatments include the Erbium and Fraxel laser modalities. Microneedling and drug delivery, with the application of a special serum, is another effective tool in the Dr Haus Dermatology treatment kit.
If you, or someone you know, are struggling with symptoms that may indicate melasma, contact us at Dr Haus Dermatology. Our experience with this frequently distressing condition, means we can understand your concern, and help you decide if a consultation might be the right next step for you.