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Unmasking Melasma: A Lesser Known, Clearly-Shown Condition

Melasma is a common skin disorder characterized by dark hyper-pigmented patches. While this discoloration usually doesn’t do any physical harm, it is known to leave one feeling out of place and self-conscious. Friends and family might reassure you that it fades with time, but melasma can be a frustrating, remitting, relapsing condition, particularly in the summers.

As one of the top 10 skin problems in the Philippines, Melasma mostly affects women between the ages of 20 and 50 years of age. Often referred to as the ‘mask of pregnancy’, Chloasma or Pekas in Philippines, the condition can be caused by anything from sun exposure or hormonal changes to genetic tendencies or even a simple skin irritation. Because the triggers vary so widely, it is best to understand possible causes and treat them better.

Estrogen and progesterone sensitivity
More often than not Melasma boils down to a hormonal imbalance. Birth control pills, pregnancy and hormone therapy can all stimulate pigmentation and cause a melasmic condition. As more cortisol is produced, hormones like progresterone and pregnenolone are depleted, which leads to an imbalance of estrogen. Being mindful of these triggers might lead you on to a specific root cause.

Exposure to sun (ultraviolet rays) and heat
All the variations in skin colour are due to the presence of a pigment called melanin. Studies have shown that melanin production gives rise to the skin colour that ultimately protects the individual from solar radiation and Vitamin D deficiency. It’s no mystery then, that Melasma is most prevalent among dark-skinned women, particularly Asians and Latinos.
You’ll be surprised by how heat can trigger melasma. Continued exposure to overhead desk lamps, ovens, grills, heating lamps and hair dryers can all trigger the condition. Melasma is thought of solely as a form of hyperpigmentation, however, heat may lead to more inflammation followed by melanin production.

Stress and thyroid disease
Patients with thyroid disease are more susceptible to melasma. Studies have shown that the overproduction of melanocyte-stimulating hormone (MSH) brought on by chronic stress can cause an outbreak of the condition.  

Genetic predisposition
While women constitute the vast majority of those affected by melasma, it’s not limited to women alone. Research has found that melasma tends to run in families, regardless of a men or women inheriting it. In fact a whopping 70% of Latino men with melasma also had a family member with it.

Other lesser-known triggers
Scented or deodorant soaps, cosmetics, toiletries, or fragrances that may cause irritation and phototoxic reactions can trigger persistent melasma. Microdermabrasion and some chemical peels procedures also often lead down the same path. Are any of these setting off an unfavourable reaction?

What does melasma look like?
Melasma is characterized by brown to gray-brown patches, and occurs broadly over 3 areas:

CENTROFACIAL
- Cheeks, Forehead, Upper lip, nose & chin

MALAR
- Cheeks and Nose

MANDIBULAR
- Side of cheeks and jaw line

Melasma is one of those skin conditions that few talk about but everyone notices. It is sometimes mistaken with dark spots or freckles, which makes it a tricky one to diagnose. Understanding the history of melasma in a patient is crucial to clearing it in the long-term. That way you should be able to help you get to the source, isolate the cause and eliminate significant recurrences.

Treatment should be driven towards reducing the size and intensity of melasma, sensible sun protection and continuous use of safe and effective treatment. To that end, procyanidin is a good direction to go in. It’s antioxidant and anti-inflammatory properties have been shown to improve decrease the area of effect of melasma, as well as reduce the intensity of pigmentation.

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