1. Melasma: Summer's Hangover
Now that summer is nearly over for many of us, it is time to look in the mirror and take stock of the damage that has been done. During the summer, women with darker skin often develop a common skin problem called melasma. Melasma is a skin condition where areas of brown pigmentation occur on the face. It occurs almost exclusively in women and is the result of excessive sun exposure. Melasma can occur in the winter, but is far more common in the summer when the sun's rays are strongest.
2. What is Melasma?
Melasma is dark spots on the face where excess pigment was produced. Pigment is produced in the skin by cells called melanocytes. Melanocytes are responsible for the baseline color of your skin as well as for darkening or tanning of your skin from sun exposure. The brown pigment helps protect your skin cells for ultraviolet radiation form the sun. In melasma, the melanocytes on your face produce excess pigment in irregular patches. This leads to noticeable dark spots. The spots occur most often on the cheeks, forehead, nose and upper lip. They can be seen shortly after sun exposure and get progressively darker and more noticeable over the summer months. Although there is an obvious color change, melasma does not burn, itch or hurt. It occurs with normal sun exposure--you do not have to experience a sunburn to develop melasma.
3. Hormones Plus Sun Equals Brown Spots
Although the cause of melasma is not clearly known, hormones, especially estrogen, are thought to be part of the problem. In fact, it is most often seen in pregnant woman who have high estrogen levels; in such cases it is called the "mask of pregnancy" or cholasma, which is just another name for melasma.
Elevated homone levels such as estrogen (and perhaps progesterone) seem to prime melanocytes in the skin to make more pigment. When the skin is exposed to sunlight, a natural trigger for melanocytes to make melanin, the hormones induce excess production, leading to irregular, dark brown spots. In addition to pregnancy, women taking birth control pills (and perhaps woman taking hormone replacement pills), are also susceptible to developing melasma.
Melasma is most often seen in women with naturally dark skin; for this reason, Asian, Mediterranean, Hispanic and Native American women are particularly prone. There is likely a genetic component as well--women whose mothers had melasma are more likely to develop the problem themselves.
4. How to Treat Melasma
The best way to treat melasma is to bleach the excess pigment from the skin. One of the more effective ways to do this is with hydroquinone. Hydroquinone is a bleaching agent that when used regularly can lighten skin. It can be found in over-the-counter products in a 2 percent concentration and in prescription medications in 4 percent concentrations or higher. A popular prescription strength hydroquinone is Tri-Luma. This medication combines the bleaching agent with a mild steroid and a retinoid to eliminate melasma. These bleaching agents can be expensive and are not covered by health insurance. In rare instances, using hydroquinone excessively or using concentrated hydroquinone can create a brown-gray pigmentation in treated areas that is even worse than the melasma.
Over-the-counter products containing soy isoflavinoids have also been shown to improve melasma. Aveeno has several facial creams and sunscreens with soy that can improve melasma after about 12 weeks of using it.
5. How to Prevent Melasma From Developing
The best way to treat melasma is to prevent it. Even if the above therapies effectively remove the pigment, it will simply return if you continue to expose your face to the sun. For some patients, it might be necessary to stop taking oral hormones such as birth control pills; of course, you should consult your physician before changing any medications. Regardless, it is critical to avoid excess sun exposure on your face. The best way to do this is to apply a broad spectrum sunscreen with SPF of at least 15 every day to your face. Wearing a hat and avoiding sun during peak hours of 10 a.m. to 2 p.m. can also minimize melasma.
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