Melasma

The exact cause is not known, but it is thought to be due to pigment-producing cells in the skin (melanocytes) producing too much pigment (melanin). Several factors can contribute to developing melasma, including pregnancy and using hormonal drugs such as birth control pills and hormone replacement. Rarely, other medical problems that affect hormones (such as thyroid problems) may cause melasma, as well as some other medications, such as anti-epileptics.

Exposure to ultraviolet (UV) light from the sun and the use of sunbeds or phototherapy can trigger melasma or make it worse. High energy visible (blue) light may also contribute to melasma, though there is no evidence that blue light from personal electronic devices has an effect on the skin.

Is melasma hereditary?

Melasma is more common in people with a family history of the condition, but it is not hereditary. 

Most people affected by melasma are upset by the appearance of it, but there are no physical symptoms. That is, the affected skin is not itchy or painful.

Melasma appears darker than the surrounding skin and can affect the cheeks, forehead, upper lip, nose and chin. It can also affect other areas of the body exposed to the sun, such as the forearms and neck. Areas of melasma are flat, not raised. 

Images DermNetNZ.

Melasma is usually recognised by doctors from its appearance. Occasionally, a dermatologist may suggest that a small sample of skin (numbed by local anaesthetic) is removed at the hospital for examination under the microscope (a biopsy) to exclude other conditions. 

Can melasma be cured?

No, at present there is no cure for melasma, but there are several treatment options that may improve appearance. If melasma occurs during pregnancy, it may go away a few months after delivery and treatment may not be necessary, although it may come back during another pregnancy. Even if it is treated, melasma often returns after stopping the treatments. 

How can melasma be treated?

Melasma treatments fall into the following categories and can be used together:

• Avoiding known triggers, such as birth control pills and hormone therapy.
• Avoiding the sun and using sun-blocking creams.
• Skin lightening creams.
• Tranexamic acid (a drug usually used to stop bleeding) can help improve the appearance of melasma in some patients. This can be taken as a tablet or applied in a cream.
• Procedures such as chemical peels, microneedling and laser therapy.
• Skin camouflage.

Management:

The most important thing you can do if you are affected by melasma is to protect your skin from sunlight exposure and avoid the use of sunbeds. Additionally, avoid using any irritating skin care products, instead opt for gentle, fragrance-free formulas.

If melasma improves, this effect can be maintained by protecting your skin from the sun.

Vitamin D advice

The evidence relating to the health effects of serum vitamin D levels, exposure to sunlight and vitamin D intake, is inconclusive. People who are avoiding (or need to avoid) sun exposure may be at risk of vitamin D deficiency and should consider having their serum vitamin D levels checked. If the levels are low, they may consider:

• taking vitamin D supplements of 10-25 micrograms per day
• increasing intake of food rich in vitamin D such as oily fish, eggs, meat, fortified margarine and cereals.