Melasma and its Causes

Melasma is a commonly acquired pigmentary melanosis of the face. Melasma was formerly known as chloasma and referred to as the pregnancy mask. Melasma pigmentation can be presented in brown macules or greyish macules covering the central face. The cheeks, forehead and chin are the most common places of melasma. The word melasma is derived from the Greek word ‘melas’, meaning black, which resembles the dark macules of melasma Melasma onset is usually after puberty, and it is rarely seen in pre-puberty patients, and the mean age of onset is 20 – 45 years old with a mean onset age of 33.3 years.

Melasma in women accounts for 90% of the population. Melasma is most common in Fitzpatrick skin types 3 to 5 due to the cell’s melanin deposition. According to Melnick, Lohani and Alweis (2016),melasma affects up to 5 million people in the United States of America and can account for up to 40% prevalence within specific populations.  

The causes of melasma are not very well known; however, research suggests that the leading cause of melasma is sunlight. UV exposure is one of the most common causes of melasma, and exacerbation of melasma can occur from prolonged UV exposure. UV exposure can disrupt the melanocyte activity and cause an upregulation of melanin within the cells, which causes pigmentation resulting in melasma. Both UVA and UVB trigger melasma; excessive UV exposure can lead to exacerbation of melasma. Martin, Hameedullah, and Sneh, (2017) report that melasma can be up to 60% more severe with UV light and causes the sufferer darker macules, which have an adverse effect on emotional wellbeing due to the visibility of melasma.

Although UV light is one of the most common reasons, pregnancy, hormones, and genetic background are also linked with the occurrence of melasma (Sekin, 2014). Studies have shown genetic predisposition coupled with melasma. Studies have indicated that family genetics can account for 54.7% of melasma occurring from genetics (Ratchi and Achar, 2011). 

Oral contraceptives are another contributing cause of melasma. A study conducted by Achar and Ratchi (2011) found that 18.6% had developed melasma from taking the oral contraceptive, which led to anxiety and depression in sufferers as a consequence of the melasma. According to Nomakhosi, and Heidi (2019), oestrogen and progesterone levels within contraceptives are seen within melasma lesions. Although melasma arising from oral contraceptive use differs, pregnancy hormones can cause the onset of melasma.

Melasma onset can be due to pregnancy and pregnancy hormones. It is said that pregnancy-related melasma has a high prevalence and can affect between 45% to 70% of pregnant women . Research suggests that melasma disappears after pregnancy, which will, in turn, result in a better quality of life for the individual as they no longer have the embarrassing macules on their face (Kothari et al. 2018 and Raveendra, Sidappa, and Shree, 2020). 

Whilst there are many treatments for melasma available know with chemical peels or new innovations of laser to treat melasma. It is always best to get a Dermatological consultation before you go ahead with any treatment. Research the information on chemical peels and other treatments available. Always got to a reputable clinic who can offer the guidance and aftercare service too.