Melasma


Melasma

Description, Causes and Risk Factors:

ICD-10-DC: L81.9/L81.1

Melasma is a Pigmentary disorder of the face involving the cheeks, forehead, and commonly the upper lip. This condition is more common in women, accounting for 90% of all cases. It appears in all racial types, but occurs more frequently in those persons with Fitzpatrick skin types IV to VI who live in areas of high ultraviolet radiation; sun exposure deepens these hyperpigmented areas.

It may be limited to the cheeks and nose or just occur overlying the jaw. The neck and, rarely, the forearms can also be affected. Areas of melasma are not raised.

The exact cause is not known, but several factors contribute. These include pregnancy, hormonal drugs such as the contraceptive pill, and very occasionally medical conditions affecting hormone levels. Some cosmetics, especially those containing perfume, can bring on melasma. There is research to suggest that it can be triggered by stress. Sunshine and the use of sun-beds usually worsen any tendency to melasma.

Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications.

There are currently no guidelines for the management of melasma and given the variations of assessing treatments it is difficult to make effective comparisons between outcomes. The group therefore recommends the development of treatment guidelines for melasma which will establish a uniform set of criteria in scoring systems and allow for critical appraisal of speci?c treatments.

Symptoms:

The symptoms of melasma are dark, irregular well demarcated hyperpigmented macules to patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Melasma is also common in pre-menopausal women. It is thought to be enhanced by surges in certain hormones.

Diagnosis:

Melasma is usually easily recognized by the characteristics of the pigmentation and its distribution on the face. Occasionally, your dermatologist may suggest that a small sample of skin (numbed by local anaesthetic) isremoved for examination under the Microscope (a biopsy) in order to exclude other diagnoses.

Treatment:

At present there is no cure for melasma, but there are several treatment options which may improve the appearance. Superficial pigmentation is easier to treat than deep pigmentation. If melasma occurs during pregnancy, it may resolve on its own within a few months after delivery and treatment may not be necessary.

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

    Avoiding known trigger factors, such as the oral contraceptive pill or perfumed cosmetics.

  • Adopting appropriate sun avoidance measures and using sun-blocking creams.

  • Skin-lightening agents.

  • Chemical peels, dermabrasion and laser treatment.

  • Cosmetic camouflage.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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