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Updated: Feb 29

Melasma, sometimes referred to as the 'mask of pregnancy' is possibly one of the most poorly understood skin conditions. Often grouped in with pigmentation and other kinds of sun spots, it’s actually a distinct condition with a unique set of characteristics and treatment.

While melasma appears on the skin as a sort of pigmented patch, it is not simply pigmentation. It is its own entity from the kind of pigmentation you might get from acne scarring. It has a very specific pattern that you don’t see with other kinds of pigmentation in that it appears on 'sun-exposed' prominences like the forehead, upper cheek and top of the collarbone. It occurs most commonly in women but men do get it sometimes. In darker skin tones, the patch will usually be your skin tone but darker; in fairer skin tones, it can have a slightly yellow or brown shade, rather than the pinkness or redness that scars can leave behind. It’s perhaps more noticeable in those with olive skin or lighter Asian skin tones, but it can affect all skin tones and types. The patches are flat, not raised, and shouldn’t be itchy or sore.

If you took a biopsy of a patch of skin with melasma, you’d see that it has a very characteristic pattern, different to any other kind of pigmentation.

So what causes it?

We don’t know for sure but there appears to be an interplay between some female hormones during pregnancy or while on hormonal contraception. There are a lot of different theories but it’s most likely to do with progesterone and oestrogen. There really is no consensus on what causes it exactly but one theory is that folate, which is produced by women during pregnancy, is destroyed by UV light, so your body produces more melanin in order to protect the folate. As such, you get these darker patches from sun exposure.

One thing we know for sure about melasma is that sun exposure exacerbates it. Depending on your skin tone, melasma may not be very visible at all during the winter months but once you catch a little bit of sun, the patches will darken even more and become more visible.

There isn’t a confirmed genetic link but if your mum or sister has developed it, it’s slightly more likely that you will, too. Generally speaking, it’s considered to be a hormonal condition more than anything else.

So how can you manage it?

It’s about induction of remission and maintenance of remission. Basically, making it start to go away and keeping it from coming back. The most common treatments for melasma is a good quality chemical peel. Dermatologists often cite hydroquinone for this situation - prescription-only in the UK. When used correctly and under the guidance of a consultant dermatologist, it treats melasma by stopping the production of an enzyme that causes melanin formation

Once the melasma has been brought into remission, you’ll need to ensure it stays that way and by that I mean wearing a broad spectrum, high factor SPF every single day and avoiding sun exposure. So big hats and staying in the shade.

It is suggested to discuss this with your doctor who may suggest changing contraception if the melasma was triggered by something like the pill.

Do you suffer from melasma? Why not book in for a skin consultation

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