Melasma Treatment in Delhi, India

Melasma is a skin condition that manifests as patches of darker skin, commonly appearing on the face. These patches are usually brown or greyish in colour and typically occur on the cheeks, forehead, bridge of the nose, and/or above the upper lip. While melasma is not harmful, it can have a psychological impact and is difficult to treat.

Broadly, there are three types of melasma:

1. Epidermal Melasma

This type of melasma affects the top layer of skin (the epidermis). It is characterised by brown or tan patches that are flat or slightly raised.

2. Dermal Melasma

It is a type of melasma that affects the deeper layer of skin (the dermis). It is characterised by blue-grey or greyish-brown patches that are deeply pigmented.

3. Mixed Melasma

Mixed melasma is a combination of epidermal and dermal melasma. It is characterised by both brown and blue-grey patches.

The exact cause of melasma is unknown, but it is thought to be triggered by a combination of factors, including:

• Sun Exposure: Sun exposure is a major risk factor for melasma. The ultraviolet (UV) rays from the sun can stimulate the production of melanin - the pigment that gives skin its colour - leading to the development of melasma patches.
• Hormonal Changes: Melasma is more common in women than men, and it is often triggered by hormonal changes, such as pregnancy, menopause, and taking oral contraceptives. These hormonal changes can increase the production of melanin.
• Family History: Melasma is more common in people who have a family history of the condition. This suggests that there may be a genetic predisposition to developing melasma.
• Anti Seizure Medications: Certain antiseizure medications, such as Clobazam (Onfi®), have been associated with melasma onset or worsening.
• Skin Care Products: Irritating skin care products can worsen melasma symptoms. Avoid harsh soaps, fragrances, and other products that cause skin irritation.
• LED Screens: While more research is needed, exposure to blue light emitted from LED screens, such as televisions, laptops, and smartphones, may contribute to melasma development.
• Phototoxic Drugs: Certain medications, such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycemics, antipsychotics, and targeted therapies can increase skin’s sensitivity to sunlight, potentially exacerbating melasma.
• Tanning Beds: Tanning beds emit UV radiation that can damage skin, leading to melasma development or worsening.
• Soaps: Some scented soaps are thought to trigger or worsen melasma.
• Makeup (Cosmetics): Certain cosmetics can cause a phototoxic reaction, increasing skin sensitivity to sunlight and potentially aggravating melasma.

The primary symptom of melasma is dark patches on the face. These patches are typically:

• Symmetrical, meaning they appear on both sides of the face.
• Brown, tan, greyish-brown, or blue-grey.
• Flat or slightly raised.
• Found on the cheeks, forehead, chin, and upper lip.

Diagnosing melasma typically involves a thorough examination of the affected skin areas. Dermatologists assess the pattern, colour, and distribution of the patches to determine the type of melasma and rule out other skin conditions that may resemble melasma. In some cases, diagnostic tests may be required to gather more information and exclude other possible causes. These tests may include:

• Wood's Lamp Examination: A Wood's lamp emits ultraviolet light that helps distinguish between epidermal and dermal melasma. Epidermal melasma appears more prominent under Wood's light, while dermal melasma shows less contrast.
• Dermoscopy: A dermoscope is a magnifying device that allows dermatologists to examine the skin in close detail, providing better visualisation of the melasma patterns and structures.
• Skin Biopsy: In rare instances, a small sample of skin may be removed and examined under a microscope to rule out other skin conditions and confirm the diagnosis of melasma.
• Thyroid Function Tests: If there is a concern about an underlying thyroid disorder, the dermatologist may recommend thyroid function tests to assess thyroid hormone levels.

There is no cure for melasma, but there are a number of treatments that can help to lighten the patches and reduce their appearance. Treatment options include:

• Topical Medications: There are a number of topical medications that can be used to lighten melasma patches. These medications include azelaic acid, kojic acid, and hydroquinone.
• Chemical Peels: Chemical peels can be used to remove the top layer of skin, which can help to lighten melasma patches.
• Laser Treatment: Laser treatment can be used to break down the pigment in melasma patches.
• Protection from the Sun: The most important thing you can do to prevent and treat melasma is to protect the skin from the sun. This means wearing sunscreen with an SPF of 30 or higher every day, even on cloudy days.

The best way to prevent melasma is to protect the skin from the sun. This means wearing sunscreen with an SPF of 30 or higher when stepping out, even on cloudy days. It is also advisable to seek shade during the midday hours and wear a wide-brimmed hat. If one is pregnant or taking birth control pills, they should consult their doctor about ways to reduce the risk of developing melasma.

Melasma can be a frustrating and bothersome condition, but there are a number of things one can do to manage it and improve their appearance.

• Be Patient with Treatment: It may take several months or even years for melasma to fade completely. Be patient with the treatment and don't give up.
• Use Makeup to Cover Melasma Patches: Makeup can be used to cover melasma patches and improve the appearance. There are a number of specialised makeup products available for people with melasma.
• Seek Support from Others: Talking to others who have melasma can help individuals feel less alone and provide them with support and encouragement.

1. Which areas of the body are most commonly affected by melasma?

Melasma most likely occurs in the following locations:

1. Shoulders and upper arms.
2. Forehead, cheeks, nose, and upper lip.
3. Both cheeks.
4. Cheeks and nose.
5. Jawline
6. Neck for people age 50 or older.

2. What foods are good for Melasma management?

While melasma specialists opine that there is no definitive cure for melasma, incorporating certain nutrient-rich foods into your diet may help manage the condition and promote overall skin health. Here are some beneficial foods:

1. Vitamin D-rich foods: Oily fish, eggs, fortified milk, and sunlight-exposed mushrooms.
2. Antioxidant-rich foods: Berries, citrus fruits, leafy green vegetables, and nuts.
3. Folate-rich foods: Leafy green vegetables, legumes, and fortified cereals.
4. Omega-3 fatty acid-rich foods: Oily fish and flaxseeds.
5. Hydrating foods: Water, fruits, and vegetables with high water content.

3. Am I more likely to develop thyroid disease if I have melasma?

Having melasma does not necessarily mean that you will develop thyroid disease. However, studies have shown an association between melasma and thyroid disorders, particularly hypothyroidism (an underactive thyroid gland). If you have melasma, your healthcare provider may recommend thyroid function testing to rule out any underlying thyroid issues.

4. What skin conditions are often confused as Melasma?

Melasma is often mistaken for several other skin conditions, including:

• Postinflammatory pigmentation
• Guttate hypomelanosis
• Nevus of Ota
• Nevus of Hori
• Drug-induced pigmentation
• Hydroquinone-induced exogenous ochronosis
• Actinic lichen planus and lichen planus
• Lentigo (age spots)

5. Do freckles qualify as melasma?

Melasma spots may occasionally be confused with freckles, yet these two skin conditions are distinct.

6. Does Melasma go away on its own?

While melasma may go away on its own in some cases, particularly when caused by hormonal changes like pregnancy or contraceptive use, it is more likely to persist if left untreated.

7. Why do women get melasma when they’re pregnant?

Melasma during pregnancy, often referred to as "pregnancy mask," is linked to hormonal changes. Increased levels of oestrogen and progesterone can stimulate the overproduction of melanin, leading to the development of dark patches on the skin.

8. How to prevent melasma during pregnancy?

Prevention involves minimising sun exposure and using broad-spectrum sunscreen with high SPF. Wearing hats and seeking shade can also help reduce the risk of melasma during pregnancy.

9. Will my melasma go away after I have my baby?

While melasma may fade after pregnancy, it doesn't always disappear entirely. Sun protection and topical treatments may be recommended to manage and lighten melasma postpartum.

10. What’s the difference between Melasma and skin pigmentation?

Melasma and pigmentation are both terms used to describe darker patches of skin, but they have distinct characteristics. Melasma is a specific skin condition causing symmetrical hyperpigmented patches on the face, while pigmentation is a general term for any skin darkening caused by various factors.

11. Is Melasma a type of cancer?

No, melasma is not a type of cancer. It is a noncancerous skin condition that causes hyperpigmentation, or darkening, of the skin.

Reviewed by Dr. Kashish Kalra - Head of Dept and Consultant, Dermatology on 10 Jan 2024.