Melasma is a common acquired pigmentary disorder affecting up to 30% of child‐bearing women in some populations. The clinical pattern is characterised by symmetrical light to dark brown patches with irregular borders. An almost constant worsening of the condition during the summer season is one of the hallmarks of this disorder.
Although treatment options are available, management of melasma remains challenging with inconsistent results & frequent relapses.
Melasma is still often called the “pregnancy mask” and has historically been considered the consequence of female hormone stimulation on a predisposed genetic background. Although these two factors do contribute to the disorder, research in the last few years has added new pieces to the puzzle.
Ultraviolet (UV) radiation as a trigger factor for melasma has been known for decades. However, even when using potent UVB & UVA protection during the summer, most patients have a worsening of their condition. The shorter wavelengths of visible light (blue-violet light) have recently been shown to induce hyperpigmentation through a specific sensor in melanocytes (pigment producing cells) called opsin 3. Sunscreens containing iron oxides and offering protection against the shorter wavelengths of visible light on top of broad spectrum UV protection can significantly reduce relapses of melasma during summer compared to UVA/UVB sunscreens alone.
The impact of female hormones may not be as strong as originally believed. Population studies show that melasma is not uncommon in men. A study of female melasma patients in nine countries across the world showed that the onset occurs during pregnancy in only 26% of cases. Almost the same number occur pre-pregnancy (29%) and 10% of cases start after menopause. The study also showed that stopping the contraceptive pill (another frequently cited culprit) only has a weak impact on the evolution of the condition. Indeed, a hypothesis is emerging that melasma is a disease of photoageing (premature ageing of the skin from repeated sun exposure). This could explain why some treatments typically used for ageing may help melasma, for example retinoids.
Post-inflammatory hyperpigmentation (PIH) occurs after there is damage or irritation to the skin. The skin affected turns tan, brown or purplish, which brings about the term hyperpigmentation (deepening of colour).
PIH can affect anyone, but is very common in darker skin. Skin of colour has more pigment (melanin) so there is more of a chance of PIH with skin conditions, such as acne.
Post inflammatory hyperpigmentation can take months to years to fully clear. For effective long-term treatment of PIH, it is essential to treat the underlying skin problem that is leading to the discolouration. In addition, certain agents can speed up the healing process, such as topical niacinamide, retinoids, azelaic acid, glycolic acid, vitamin C and kojic acid. There are also very effective prescription creams and chemical peels that may improve the outcome beyond skincare products alone.
Sunlight causes PIH to darken, so it is essential to utilise protection from the sun (sunscreen & sun-protective clothing) on the areas involved.
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