Melasma is a very common skin problem that causes brown patchy pigmentation of the face. It can be embarrassing and distressing. The pigmentation is caused by overproduction of melanin in the upper layers of the skin. Contributing factors include sun exposure, pregnancy, birth control pills and cosmetics and it is more common in women. Melasma usually becomes more noticeable in the summer and improves during the winter months.
Generally a combination of the following measures is helpful:
Daily high protection factor (SPF>40) sunblock 365 day a year. A physical blocking agent containing zinc oxide or titanium dioxide is more effective and less likely to cause irritation in those with sensitive skin. It should be reapplied every 2 hours if outdoors during the summer months.
Use gentle cleansers and moisturisers.
Cosmetic camouflage (make-up) can help to disguise the pigment.
Avoiding known trigger factors, such as the oral contraceptive pill.
Your dermatologist can prescribe a combination of the following treatments:
Hydroquinone: this is the gold standard and most effective treatment for melasma and works by lightening pigmented areas of skin. The depigmenting effects become evident after 5-7 weeks and treatment should be continued for at least three months
Tretinoin is a vitamin A analog which effects multiple steps in the pigmentation process and helps enhance the penetration of hydroquinone.
Topical corticosteroids can help lighten the skin while decreasing irritation caused by hydroquinone or tretinoin.
It is imperative that chemical peels and laser treatments are only performed under the supervision of a dermatologist as these treatments can paradoxically worsen melasma.
Successful treatment of melasma often takes several months.
Read more about treatment of melasma from the American Academy of Dermatology