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Melasma is condition of abnormally darkened skin that occurs mostly on the face of pregnant women. This condition is also known as Chloasma faciei or the mask of pregnancy. However, melasma can also occur in women that are not pregnant and is always related to some form of hormonal imbalance often a result of hormone replacement therapy or the use of birth control pills.

What Does Melasma Look Like?

Melasma usually manifests as darkened areas located on your upper cheek, nose, lips, upper lip, and forehead. These hyperpigmented areas can look like discrete freckles or may appear as patches which may develop gradually over time. 

What Causes Melasma?

Melasma is thought to result from the excessive stimulation of melanocytes (pigment-producing cells) under the influence of female sex hormones such as estrogen and progesterone. These hormone sensitive melanocytes will consequently lead to irregular skin coloration especially when these areas of skin are exposed to sunlight.

Melasma is most prevalent in women that have light brown skin and have been exposed to intense levels of sunlight. There is also some genetic predisposition to melasma.

Any condition that increases melanocyte stimulating hormone (MSH) can increase your risk of developing melasma.  MSH is produced in a specific part of your brain known as the pro-opio- melano-cortin receptor (POMC). Your POMC is influenced by thyroid disease, sun exposure, various forms of stress and adrenal disease.

A specific form of melasma known as Melasma Suprarenale can be a symptom of Addison’s disease (adrenal cortex failure) that results in excessive production of adrenal cotico tropic hormone (ACTH) which as affects your POMC.

It is likely that any form of excessive stress that leads to overstimulation of ACTH can contribute to the development of melasma. 

Treatment of Melasma

  1. Identify and rectify any hormonal imbalances that are contributing to the problem in the first place – for example – cessation of birth control pills (synthetic, non bio-identical sex hormones) – cessation of inappropriately administered hormone replacement therapy (HRT) – improvement in adrenal function and adrenal stress and fatigue through the amelioration of factors that contribute to adrenal stress and fatigue (dietary, hormonal, immune system and nervous system therapies)
  2. Avoidance of sun exposure and use of sun blocking agents
  3. Use of topical depigmenting agents such as hydroquinone. Azelaic acid Tretinoin to increase the rate of fading of discolored skin patches.
  4. Chemical peels – to remove the outermost layers of hyperpigmented skin
  5. Microdermabrasion – to remove the outermost layers of hyperpigmented skin.
Patient with Melasma (Before Treatment)