Melasma and Chloasma: Unmasking the Truth

Concerned with mottled brown marks on your skin?

That once made your skin sun-kissed, but now, they are morphing into frustrating brown patches?

We all want clear, glowy, dew like skin in an ideal world, minus uneven skin tone and dark blemishes.

But like every journey in your life, you can’t have a success story without first going through a few hoops. Healthy skin is a process, and sometimes even dark spots are almost impossible to avoid.

So join us as we decode exactly what are these marks, and how can they be treated?

Melasma and Chloasma

Understanding dark spots on your skin

Hyperpigmentation is a term used in the skincare industry to describe patches of skin that may have more pigmentation than others. The contrast with surrounding unaffected skin leads to the unevenness of skin colour and tone.

There are a few different kinds of dark spots that we get on our skin that are important to ID before selecting the right products necessary to treat them:

Photodamage induced by chronic UV exposure can lead to the appearance of lentigos, or sunspots, a condition referred to as actinic bronzing where sun-exposed areas are darker and uneven.
Post-inflammatory hyperpigmentation (PIH). This is more common in darker skin tones, often seen as acne, where dark spots are left after the acne lesions disappear and after any trauma to the skin, such as scarring.
Lentigos and actinic bronzing, those with lighter skin are more susceptible; they are often called sunspots. A condition is known as actinic bronzing, where sun-exposed areas are darker and uneven. Whilst those with darker skin tones more susceptible to post-inflammatory hyperpigmentation

And of course, there is also melasma, as discussed below.

Understanding melasma

Melasma is the most common form of hyperpigmentation, and much remains to be understood about the origin and development of this disorder.

Melasma is more common in women and with darker skin tones. Hyperpigmented patches develop primarily on the cheekbones, forehead, and upper lip and can also be on the nose, chin, lower cheeks, and neck.
Your tendency to develop melasma is based on both genetic and is often induced by birth control pills and pregnancy and can be exacerbated by sun and heat.

What is known is that pigment cells in the epidermis, known as melanocytes, are constantly stimulated to produce melanin; it seems no shut-off valve deactivates the cells found in the skin.

It characterised by uneven skin tone, facial discolouration, and irregular brown patches. It has a common pattern:

• the centre of the face is most prevalent, including the forehead, nose, cheekbones, upper lip, jaw, and chin
• it can also be found on the sides of the neck
• occasionally, it can be found on the upper arms and forearms

Not all pigmentation is melasma

Some common diseases can be mistaken for this condition, so you mustn’t assume that your problem is only localised in the skin. Not all pigmentation is melasma.

• the failure of the adrenal glands can cause dark pigmentation, known as Addison’s Disease
• polycystic Ovarian Syndrome is another common disease amongst women
• hemochromatosis can cause dark pigmentation of the skin
• lupus, Cushing’s Disease, and systemic sclerosis can also cause hyperpigmentation
• drug-induced pigmentation accounts for around 15% of pigmentation cases. Non-steroidal anti-inflammatory drugs, cytotoxic drugs for cancer, and phenytoin – a drug used for epilepsy – all-cause hyper-pigmentation on the skin similar to melasma

Getting to grips with chloasma

If you’re pregnant, you know to expect the unexpected – especially when it comes to changes in skin tone.

When melasma occurs during pregnancy, it is referred to as chloasma and occurs in 10-15% of pregnant women – it isn’t referred to as “the mask of pregnancy” for nothing.

So why is it that pregnant women are so susceptible to dark patches on the skin? During pregnancy, all our hormones, including estrogen, progesterone, and the melanocyte-stimulating hormone MSH, increase, and it is this increase of progesterone that creates chloasma.

Studies have also found, women who receive progesterone hormone replacement therapy for postmenopausal conditions are also more likely to develop this condition.

For those with chloasma, sometimes the discolouration will disappear following pregnancy or if birth control pills and hormone therapy is discontinued.

A look at other triggers

Melasma is believed to be more estrogen-responsive, which is why far more women than men get it; the ratio sits around 1-in-4 women to 1-in-20 men and generally starts from the early ’20s to ’40s.

Triggers associated with melasma include race, genetics, skin types, age, sun exposure, internal disease or inflammation, pregnancy, and hormone dysfunction.

Underneath the brown colours visible to the naked eye are inflammation and redness. This inflammation stems from the liver, resulting from hormones related to birth control pills or pregnancy after 30.

To treat the spots, the liver damage has to be healed; trioxolane has shown promising results in healing the liver damage internally.

Lightening spots can be hit or miss topically, but inflammation can be calmed, and topical application requires healing the source.

Other possible causes of melasma are:

Oral contraception: 10-25% of women on the pill can expect to suffer from this condition

Sun Damage and genetics: Over-exposure to UV deepens pigmentation, activating the melanocytes to produce more melanin – especially in those genetically pre-dispositioned to the condition. Research has found individuals typically develop this in the summer months, when the sun is the strongest.

Skin tone: Those more susceptible usually have darker skin tone; Asian women, such as Fitzpatrick skin type 3-4, have a 40% chance of getting melasma.

Hormonal Treatment: Whilst the relationship between hormones and this condition is not fully understood, research points to a link between melasma and hormone replacement therapy or intrauterine implants.

Medications: Certain medications, such as anti-seizure medications, stimulate melanin, making the skin more prone to pigmentation after exposure to ultraviolet.

Fragrances: Some fragrances are a trigger, causing a photo-toxic reaction in the skin.

Conclusion

As we can see, both these are a result of hyperpigmentation issues.

If you are concerned you have either melasma or chloasma, a consultation with a skincare specialist is recommended; by assessing your skin under a woods lamp, the skincare specialist will be able to identify the depth of pigment and find out whether it is epidermal, dermal, or both.

This will help you determine how successful you are likely to be in treating it, and it will also give you an idea of the type of treatments available for your particular concern.

Just so you have realistic expectations, it is important to note that chloasma is very difficult to treat.