Melasma is a common skin problem not many of us know about. It appears as dark patches on your skin, primarily on the face. It is more common in women than men, with 90 percent of people suffering from it being female. This is more prominent to people of Asian, African, and Hispanic descent—those living in areas with high UV light exposure.

Melasma also affects pregnant women, which is why it’s called the “mask of pregnancy” or Chloasma. Though a person’s genetic predisposition may be an underlying cause, it’s believed that your exposure to sun, skin irritation, and hormonal changes also play a big part.

Major Cause of Melasma

Exposure to sunlight UV radiation can cause peroxidation of lipids in cellular membranes, leading to generation of free radicals such as an unbalanced diet, not getting enough sleep, stress, smoking, etc.

These free radicals could stimulate and trigger melanocytes to produce excess melanin.

Classification

There’s three types of Melasma occurrences:

Epidermal Melasma affects the topmost layer of skin, with the hyperpigmentation appearing as brown patches with well-defined borders. This is the most common type of melasma and the most responsive to treatment.

Dermal Melasma affects the deeper layer of the skin and is characterized by gray-brown patches. It’s harder to treat because the pigment resides deeper in the skin.

Mixed Melasma is a combination of Epidermal and Dermal Melasma patches in the same person, that is visible as gray-brown patches.

Clinical Patterns

Centrofacial Melasma has dark patches appearing on your forehead, cheeks, upper lip, nose, and chin.

Malar Melasma meanwhile has patches appearing on your upper cheeks, specifically around your cheekbones.

Mandibular Melasma is characterized by dark patches on your jawline.

Melasma vs. similar conditions

Because melasma presents as patchy hyperpigmentation, it can often be confused with other pigment-related skin disorders. However, knowing the difference is key when it comes to both diagnosis and treatment.

Take Vitiligo for instance. Though it’s also a skin condition, it’s related to the absence of melanin in the skin, while melasma is about the overproduction of melanin. Additionally, though melasma seems to be genetically linked, it’s triggered by other factors like sun and hormonal changes. Vitiligo on the other hand is hereditary, and present in a person from birth. It also appears as whiter patches all across the body.

MELASMA (“Pekas”) vs. Vitiligo

The Reverse

Classification

MELASMA

Vitiligo

Origin

Acquired

(overproduction of melanin)

Acquired

(absence of melanin)

Skin Tone

Brownish skin tones

Fair-skinned people

Development Period

Adulthood

Childhood through  adulthood

Appearance

Patches  ( symmetrical)

Patches (scattered)

Color

Brown, grey-brown

White

Pattern

Centro-facial, malar, mandibular

Typically all over the body

Even more similar to melasma however are freckles. These are when a person has spots all over their face, and sometimes all over their body. It’s also hereditary, like vitiligo, but shares the same cause as melasma such as the overproduction of melanin. Freckles however affect people of lighter-skinned ancestry, in the US and Europe. Though present from childhood, they can be triggered by the UV rays in sunlight, progressively getting darker over their summers and lighter in the winter months.

MELASMA (“Pekas”) vs. Freckles

The Big Difference

Classification

MELASMA

Freckles

Origin

Acquired

Hereditary

Skin Tone

Brownish skin tones

Fair-skinned people

Development Period

Adulthood

Childhood through  adulthood

Appearance

Patches

Spots

Color

Brown, grey-brown

Brown, red, tan, yellow

Pattern

Centro-facial, malar, mandibular

Typically on the cheeks, around eye area

Risk Factors

  1. Sun Exposure - the major risk factor resulting in dark spots or hyperpigmentation.

  2. Hormones - intake of oral contraceptives, anti-seizure drugs, and hormonal replacement medication.

  3. Cosmetics - Use of astringent and peeling agents with harsh ingredients.

  4. Genetics - Having family members who have melasma gives a higher chance to develop the condition.

Treatment Options

The challenge in treating melasma is the reduction in size and intensity as well as the prevention of recurrences. 

The biggest thing to remember here is that you need to care for your skin when you have melasma. Try to minimize your sun exposure with appropriate clothing, as well as hats and sunglasses, and stay far away from skin irritants like exfoliants, bleaching agents, and chemical peels. 

Currently, getting rid of melasma can be achieved through a combination of sensible sun protection and continued use of safe and effective therapies and treatments such as below.

Available Treatment

Examples

Mode of Action

Possible Side Effects

Oral Medicine

Procyanidin, Ascorbic acid, Beta-Carotene, and D-alpha-Tocopheryl acetate

Combats melasma at its root, fights damaging free radicals, and control overproduction of melanin

Minor stomach upset

Topical Depigmenting Agents

Hydroquinone

Blocks the normal production of melanin 

Skin irritation

Ochronosis

Peeling Agents

TCA/Glycolic Acid

BHA

Increases keratinocyte turnover 

Skin irritation

Photosensitivity

Laser Therapy

IPL

Q switched NdYag

Disruption of melanocytes

Atrophy

Hypertrophy

Hypopigmentation

Hyperpigmentation