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International Academy of Cosmetic Dermatology

MELASMA

Melasma is an acquired condition, also known as chloasma or the “mask of pregnancy,” because it usually occurs during the second or third trimester of pregnancy.  Melasma is a type of hyperpigmentation and is caused by an increase in melanin, the substance responsible for color (pigment).  The disease is more common in women due to taking oral contraceptives, hormone replacement therapy, or excessive sun exposure; however, under some circumstances, it can occur in men.

Although not a harmful disease, it can severely affect a person’s cosmetic appearance.  Characteristic signs of melasma include the slow development of brown patches on the face and neck.  The brown patches may be located superficially in the epidermis (epidermal melasma), deeply in the dermis (dermal melasma), or a combination of both.

The most important recommendation is minimizing sunlight exposure in order to avoid worsening the condition.  Sunscreens of SPF 15 or higher should be used for the best protection, especially those containing zinc oxide or titanium dioxide and Parsol 1789 (avobenzone).   Depigmenting agents, also known as “bleaching” creams, most commonly hydroquinones, are available over the counter, as well as by prescription.  Bleaching cream can also be combined with other agents such as tretinoin and glycolic acid to improve the efficacy of the medication.  The depigmenting effect can be slow and usually requires application over several months.  Epidermal melasma treatment is much more successful than therapy of dermal melasma.  Chemical peels, microdermabrasion, and even some lasers can be effective treatments.

Robert A. Norman, DO, MPH
Tampa, FL, USA

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