Melasma causes patchy light to dark brown skin discoloration on the face. Like a mask, it hides the real face of the wearer, causing women from around the world to lose sight of their beauty and confidence. While it is not a life-threatening condition, this skin disorder may negatively affect the quality of life and self-esteem of those who suffer from it.

To make matter worse, melasma may develop during the two difficult phases in a woman’s life — pregnancy and menopause. These are periods in the life of women when inevitable hormonal changes occur and lead to undesirable symptoms like mood swings, fatigue and sleeping problems. Adding melasma to the picture can only intensify the anxiety and discomfort that women maybe going through during these periods.

To help them properly deal with this skin condition, women should be well-informed about the basics of melasma. In this article, we sought the expertise of Dr. Chan Lee Chin, a Senior Consultant Dermatologist to share some useful information about this condition.

Hyperpigmentation disorder common in women

Melasma is an acquired skin condition which typically develops as symmetric hyperpigmentation on the face. Melasma is likely to occur when the pigment-making cells in the skin called melanocytes produce too much pigment. It is triggered by factors including sun exposure, hormonal changes, use of birth control pills, hormone replacement medicine, and application of certain skin care products.

Though it may affect all races and sexes, melasma affects mostly women with darker skin tone. It is often associated with the female hormones — estrogen and progesterone. This skin condition commonly occurs during pregnancy, in women taking oral contraceptives, and in women taking hormone replacement therapy during menopause.

Options available to treat melasma

While there is no cure for this skin disorder, there are several treatments that can help lessen or manage the effects of melasma. As first-line therapy, topical treatments are available in the form of a lotion, cream, gel or liquid. Commonly prescribed topical agents are hydroquinone, azelaic acid, kojic acid, retinoids, topical steroids, glycolic acid, mequinol, and arbutin. Likewise, combinations of different topical agents have been found to be more effective in treating melasma. The most widely used combination therapy is called ‘triple combination’, a formulation that contains hydroquinone, retinoic acid and corticosteroids.

There are also oral treatments for melasma. For example, tranexamic acid (TXA) is an emerging oral treatment that has proven efficacy in treating melasma. TXA can also be given as a topical preparation or as intralesional agent. Moreover, there are procedural treatments for melasma such as chemical peels, microneedling, microdermabrasion, dermabrasion, laser treatment, and light-based procedure.

Melasma during pregnancy

Despite the many options to treat melasma, pregnant women are usually hesitant to do something about their “mask of pregnancy” for fear that the medication may be harmful to the baby in their womb. Melasma is also more resistant to treatment during pregnancy due to the presence of persistent hormonal trigger. Thus, it is usually recommended to defer treatment until after delivery.

Moreover, melasma that has been triggered by pregnancy or use of birth control pills may fade on its own after delivery or pill intake. Hence, the best way to treat melasma during pregnancy is to practice sun avoidance and protection. Sunscreen should be used every day, even on cloudy days and after swimming or sweating. To protect the skin from the effects of the sun’s rays, a broad-spectrum sunscreen with protection against ultraviolet A (UVA) and ultraviolet B (UVB) rays must be applied at least 15 minutes before stepping out and reapplied every two hours.

Melasma during menopause

Melasma can also develop during a woman’s menopause phase. At this point in a woman’s life, the ovaries stop producing the hormones estrogen and progesterone. Such hormonal changes may also trigger several skin changes including melasma. Additionally, women who take hormone replacement therapy during menopause have an increased risk of developing melasma.

Aside from applying a good sun protection product, women in their menopause phase may consider using topical treatments for melasma. However, it is best to consult a dermatologist to have the diagnosis confirmed, to rule out other diseases and to provide the best treatment option.

Women do not have to miserably hide behind the “mask” of melasma. There are several ways to prevent and treat this skin condition. Being well informed about the triggers and treatments is the first step to conquering melasma and restoring women’s confidence

References:
The effect of melasma on self-esteem: A pilot study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986109/

Melasma: an Up-to-Date Comprehensive Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574745/#!po=52.4390

Melasma
https://medlineplus.gov/ency/article/000836.htm

Topical Treatment of Melasma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807702/

New Oral and Topical Approaches for the Treatment of Melasma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374710/

Safety of skin care products during pregnancy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/

Melasma
https://www.aad.org/public/diseases/a-z/melasma-overview