Melasma: not just a skin condition of pregnancy
Why do women get Melasma?
The word Melasma comes from the the Greek work ‘Mela’ meaning black, similar to Melanoma.
Melasma occurs because melanin, the normal pigment found in the deeper level of the skin (the epidermis), travels to the top layer of the skin, known as the Dermis. If a skin biopsy is taken it will show that melanin is present in the top dermal layer. It is not clear why this happens, but hormones from the pituitary gland can stimulate the process in certain conditions, pregnancy being one of them.
What are the causes of Melasma?
Being Pregnant,
Taking Medications that increase in melanin formation in the top layer of the skin, called the Dermis. This is the cause of skin hyperpigmentation in around 10–20%. Common drugs being chemotherapy treatments, anti-epileptics, oral contraceptives, non-steroidal anti-inflammatory drugs, and other drugs such as amiodarone and chloroquine,
have thyroid disease and other hormone disorders related to the pituitary gland,
Over exposed to sunlight while pregnant,
Hereditary,
Unknown.
This is what Melasma looks like.
You can see the patchy, dark discolouration on the cheek. In this case it came on during a second pregnancy while in a hot country where UV radiation is higher.
Wearing sunblock during pregnancy, even in colder less sunny climes, is a useful strategy to prevent this; you never know if you will be affected.
Can melasma be treated?
Avoidance of sun exposure while pregnant is very important even if you don’t think you are at risk of Melasma. Wear a hat and sunblock with a factor 50+spf and avoid direct sun on your skin during 12-4pm in hotter countries. You should be taking a vitamin D3 supplement so don’t worry too much about getting extra sunlight. If you develop Melasma during pregnancy it may disappear on its own in the 12 months after delivery.
If you are not pregnant then it is useful to look at your medications and see if anything is new, that could be causing the Melasma. Speak to your doctor, it may be that you have an underlying thyroid condition or something related to the pituitary gland, which helps regulate hormones.
There is no ‘cure’ for melasma, but there are lots of things that can improve its appearance. Retinoid creams are useful after pregnancy- you cannot take them during pregnancy as they are toxic to your developing baby. Chemical peels can also reduce the pigment in teh outer layer of skin and many women find these useful.
Hydroquinone
Retinoids
Over the counter creams from skin care lines such as Clinique also can give good results
Wearing a foundation to cover over the pigmentation may be all you need
Chemical peels ( as mentioned above these remove the outer layer of skin cells where the melanin had gathered)
Laser therapy ( this is expensive but may be useful if creams have not worked and you still feel your skin is discoloured)
Recently the use of a tablet called tranexamic acid-normally used for reducing heavy periods-has been shown to lessen Melasma in Asian women who were unresponsive to other treatments. It can cause side-effects, so it is best to try the simple measures first. You can read more here
General advice for Melasma
My initial advice is don’t panic. If its pregnancy related it will probably improve with skin protection from sunlight and the use of an over-the-counter skin lightening cream.
If it is caused by a medication then stopping the medication if you have that option usually helps, although this is not the case for everyone.