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Some Known Causes of Melasma

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 16 in the March 9, 2011 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Melasma is a common skin condition occurring more often in dark skinned women. It is characterized by patches of characteristic darkening often found on the face. The diagnosis can be made with a simple office examination.

Melanin is a dark pigment produced by special cells called melanocytes. Its role is to protect us from the harmful rays of the sun. Ultra-violet rays stimulate the production of melanin by melanocytes resulting in our skin cells accumulating this pigment also known as a "tan". This same melanin imparts color to our hair and to the iris of the eye.

There are two types of melanin pigment found in humans. Melanocyte activity is controlled by a hormone called MSH (melanocyte stimulating hormone) which is secreted from the pituitary area of the brain. Hormonal changes which influence the pituitary can in turn modulate the appearance of melasma.

Things like the birth control pill and estrogen replacements are known causes of melasma. When the melanocytes malfunction and take on cancerous activity, we refer to this as melanoma, which is an aggressive type of cancer. Melasma does not lead to melanoma.

During pregnancy women often notice their faces darkening. This is called the "mask of pregnancy" or more commonly chloasma. It is essentially the same thing as melasma. Pregnancy is a high progesterone state, which influences the pituitary and stimulates melanin production. It often clears after delivery.

Women most bothered with melasma tend to be around the menopausal age. The pituitary gland becomes more active at menopause and secretes larger amounts of other messenger hormones when the ovaries stop functioning. This may stimulate the appearance of melasma. Avoiding sunlight helps.

Dermatologists may prescribe creams containing hydroquinones to treat the condition. These creams slowly de-pigment the skin areas and take months to do so. At times they may be mixed with various steroids, tretinoin or glycolic acid. The use of a sunscreen is essential in anyone with a family history of melasma. Second line treatment may consist of employing certain antibiotics to inhibit DNA synthesis and certain mitochondrial enzymes in the hopes of decreasing the hyperactivity of melanocytes. Attempts to fix the problem quickly using chemical peels and lasers have not been met with consistent success yet.

Related resources:

Melasma from Wikipedia, the free encyclopedia.

Melasma from MedlinePlus Medical Encyclopedia.

Melasma from American Academy of Dermatology (AAD).

Melasma - Alternative names: Chloasma; Mask of pregnancy; Pregnancy mask; Hypermelanosis, plus Definition, Causes, incidence, and risk factors, Symptoms, Treatment, etc. from MedlinePlus Medical Encyclopedia.

Chloasma, Melasma (facial pigmentation) from DermNet NZ.

Melasma: Article by Andrew D. Montemarano, Consulting Staff, Skin Cancer Surgery Center.

Melasma from Health in Plain English. Includes photo of Melasma: skin discoloration usually seen during pregnancy. Symptoms of Melasma, Causes of Melasma, Who Gets It, Treatment of Melasma.

Melasma Mask of Pregnancy from the Skin Site with photos.

Melasma / Chloasma with illustrations from DermNet NZ.

Melasma from Medical News Today.

Hyperpigmentation from Healthline.

Melasma: Pregnancy Mask from WebMD.

How to Decrease Hyperpigmentation.

How to Fade Hyperpigmentation.

Skin changes during pregnancy: Chloasma (pigmentation changes on your face and neck) from Baby Center. "Exposure to sunlight will darken the patches, making them more obvious, so protect your skin with a high factor sunscreen (SPF15 or more) and/or hat whenever you go out . . . They will begin to fade within three months of your baby's birth."

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