Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, Middle Easterners and Northern Africans tend to have Melasma more than others.
The precise cause of melasma is unknown. People with a family history of Melasma are more likely to develop melasma themselves. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy. Birth control pills may also cause melasma; however, hormone replacement therapy used after menopause has not been shown to cause the condition.
Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes, in the skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.
While there is no cure for melasma, many treatments have been developed. Melasma may disappear after pregnancy; it may remain for many years or a lifetime. Sunscreens are essential in the treatment of melasma. They should be broad-spectrum, protecting against both UVA and UVB rays from the sun. An SPF 30 or higher should be used. In addition, physical sunblock lotions and creams, such as Zinc Oxide and Titanium Oxide, may be used to block ultraviolet radiation and visible light. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors.
Any facial cleansers, creams or makeup which irritates the skin should be stopped, as this may worsen the melasma. If melasma develops after starting birth control pills, it may improve after discontinuing. Melasma can be treated with bleaching creams while continuing the birth control pills.
Chemical peels, microdermabrasion and laser surgery may help melasma, but results have not been consistent. Generally, they should only be performed by a dermatologist in conjunction with a proper regimen of bleaching creams and prescription creams tailored to your skin type.
People should be cautioned against non-physicians claiming to treat melasma without supervision because complications can occur. Management of melasma requires a comprehensive and professional approach by your dermatologist, who can lead to a successful outcome.