Melasma is a patchy pigmentation of the face, sometimes arising for the first time during pregnancy and fortunately, for the majority of women, fading after delivery. However, in some women it does not fade.
Some women first notice it while taking the oral contraceptive pill, but it does not always disappear after the pill is stopped. In addition, there are people in whom it develops without any obvious hormonal explanation.
Interestingly, the condition is not confined to women – it is occasionally seen in men, especially in those with olive or darker complexions from Southern Europe, the Middle East or Asia.
The commonest sites for Melasma to appear are on the forehead, upper cheeks, upper lip and chin.
In the majority of women the condition is caused by ultraviolet light acting on sensitised pigment-producing cells in the skin. Oestrogen hormones appear to render the pigment-producing cells in certain areas of the face more sensitive to ultraviolet light. When these sensitised cells are then exposed to sunlight, they are stimulated to produce excessive melanin pigment, hence the pigmentation.
In males (in whom low levels of oestrogen hormone are normally present) and those women without an obvious excess of oestrogen hormone, it has been suggested that in these circumstances, the melanin-producing pigment cells (the melanocytes) become sensitised by the body’s normal levels of circulating oestrogen hormone and start to produce excess melanin pigment when exposed to ultraviolet light.
The treatment of Melasma can prove equally frustrating for both patients and professionals but newer treatment strategies have been encouraging in terms of better control and in some cases permanent removal of the pigmentation
Understandably, based on the very way Melasma comes about, it is impossible to predict which patients will respond successfully to treatment and be rid of their Melasma permanently, and who will relapse after treatment.
Accordingly, patients must approach any treatment for Melasma realistically and accept the possibility that recurrences could occur and require further treatments.