Melasma – Tan and Brown Patches And What To Do About It

By Oge Onwudiwe, MD

AllPhases Dermatology, LLC

. https://www.allphasesdermatology.com/

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Melasma – Tan and Brown Patches And What To Do About It

It's springtime and we are all looking forward to the beautiful sunny days ahead. We must remember that sun protection is key to playing safe in the sun as well as reducing the risk of developing skin cancers such as melanoma. In addition, this helps prevent the development of other sun-induced skin conditions such as wrinkles, lentigines (liver spots) and melasma.

Melasma, also referred to as chloasma, is a relatively common skin condition mainly seen in women of childbearing age. It typically presents as symmetrical tan to brown patches on the forehead, cheeks, nose, upper lip and/or chin. Less commonly, it can also be seen on other sun-exposed areas such as the forearms, chest and neck. It is a chronic, non-life threatening condition, which can have a negative impact on one's quality of life. The root cause of melasma is currently unclear.

Well known triggers include ultraviolet rays, pregnancy, birth control and hormone replacement therapy. Prolonged exposure to heat and skin irritation from harsh chemicals with subsequent inflammation have been known to exacerbate this condition. Persons with darker skin types are at higher risk of developing melasma African-American or people of African descent, Asian, Latin American/Hispanic, Indian, Mediterranean and Middle Eastern. A dermatologist on physical examination can typically diagnose this condition and rarely is a biopsy needed.

Melasma is currently without a cure and has the potential for relapse. There are many treatment options to successfully fade the discoloration, but if sun-protective measures are not strictly adhered to or if one becomes pregnant, is on birth control or hormone replacement therapy, there can be a high rate of recurrence.

Sun protection is arguably one of the most important factors in preventing and treating melasma. This means religiously wearing sunscreen daily and reapplying the sunscreen every two hours if out for prolonged periods. Wearing a wide-brimmed hat when outdoors is also recommended.

Sunscreens with broad-spectrum (UVA/UVB) coverage, a sun protection factor (SPF) of 30 or more is ideal. The presence of zinc oxide and/or titanium dioxide in sunscreens to physically limit the effects of the sun is recommended as well.

Initial treatment of melasma usually involves the use of topical lightening agents such as hydroquinone. This is usually combined with other depigmenting or lightening agents such as ascorbic acid, azaleic acid, glycolic acid, kojic acid and tretinoin. Caution should be taken to avoid irritation with the above agents as this can worsen the condition. If these first line measures fail, your dermatologist can introduce chemical peels and/or microdermabrasion either alone or in combination with topical therapy.

Lasers should be used with caution in the treatment of melasma and should not be used as sole therapy as there is a high risk of rebound and worsening of melasma after laser use even in the most skilled hands. Remember, it may take a few months of treatment to see improvement, so don't give up too quickly.