Melasma is a very common skin pigmentation. This usually appears as asymmetrical, blotchy, brownish colored facial pigmentation. This condition is more common in females than males. This pigmentation usually starts between the age of 20 to 40, but can also begin in childhood also. It is more common in people having type 3 and 4 skin type, who gets easily tanned after exposure to the sun. Continuous sun exposure causes deposition of pigment in dermis & this often persist long-term. Many of the patients have a family history of Melasma.
Etiology of melasma is very complex. The pigmentation is mainly due to overproduction of melanin by the pigment cells, melanocytes. Melasma can of various type Epidermal, Dermal or Mixed.
Triggers for melasma:- There are various factors which may trigger the melasma & make it more worst. These include
This complex etiology of melasma leads to unsatisfactory results after treatment in some cases. General treatment measures include discontinuation of hormonal treatment, Use of broad-spectrum sunscreen along with physical protection with sun coat, scarf, wide-brimmed hat should be used.
Topical treatment includes the use of creams containing Azelaic acid, Kojic acid, Vitamin C, Tranexamic acid. Creams containing skin lightening agents like arbutin, deoxyarbutin can be tried. Nowadays various vascular lasers are also tried which also gives better results.
Treatment of Melasma is individualized. Every patient of melasma needs to be treated differently depending upon a level of pigment & type of skin. Multiple treatment modalities should be used to get the best outcome rather than monotherapy. Even with combination treatment approach, few patients get good improvement, while other get better. However, we recommend patients to take treatment to improve the pigmentation & make it more stable.
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