Melasma is one of the most common types of pigmentation disorders of the skin. It is a benign but aesthetically bothersome condition, characterized by brown or brownish patches on sun-exposed areas of the skin, mainly on the face. Although it is not associated with serious medical complications, it significantly affects the psychology and self-confidence of patients. Melasma is more frequently observed in women of reproductive age, but it can also occur in men. Understanding its causes, diagnosis and treatment options is of paramount importance for its proper management.
What is melasma?
Epidermal melasma, where the pigmentation is limited to the epidermis.
- Επιδερμικό μέλασμα, όπου η μελάγχρωση περιορίζεται στην επιδερμίδα.
- Dermal melasma, with localization in the dermis.
- Mixed melasma, which combines characteristics of both skin layers.
The accurate diagnosis of the type is important for choosing the appropriate treatment strategy.
Causes and risk factors
The appearance of melasma is due to a combination of genetic, hormonal, and environmental factors. The main causes include:
- Hormonal changes: Pregnancy, use of contraceptives, or hormone replacement therapy.
- Sun exposure: Ultraviolet radiation activates melanocytes and intensifies pigmentation.
- Genetic predisposition: Individuals with a family history are at increased risk.
- Medications or cosmetics: Some can cause photosensitivity and contribute to the appearance of lesions.
Melasma may worsen during the summer months due to intense sunlight and improve in winter.
Symptoms and clinical presentation
The main manifestation is the appearance of symmetrical brown spots on the face. The lesions have ill-defined borders and vary in color, from light brown to dark brown. They are not accompanied by itching or pain. Although usually confined to the face, in some cases they may also appear on other exposed areas, such as the neck and upper limbs. The cosmetic alteration is the main concern for patients.
Melasma: Diagnosis
The diagnosis of melasma is primarily made clinically through examination by a dermatologist. For better assessment, a Wood’s lamp can be used to help determine the depth of the pigmentation. In very rare cases, a biopsy may be performed, mainly to differentiate it from other skin disorders. Accurate diagnosis allows for the selection of the most appropriate treatment.
Melasma: Treatment Options
The management of melasma is often challenging and requires patience. There is no single treatment, but rather a combination of methods tailored to each patient.
- Topical Treatments:
- Κρέμες με υδροκινόνη, ρετινοειδή ή αζελαϊκό οξύ.
- Συνδυασμοί δραστικών ουσιών που ενισχύουν τη λευκαντική δράση.
- Αντιοξειδωτικά (ασκορβικό οξύ, νιασιναμίδη, βιταμίνη Ε, φερουλικό οξύ) και ενυδατικά προϊόντα που βελτιώνουν τη συνολική υγεία του δέρματος.
- Ιατρικές θεραπείες
- Χημικά peelings με γλυκολικό, σαλικυλικό, μανδελικό, γαλακτικό και τριχλωροξικό οξύ (χαμηλής συγκέντρωσης) .
- Laser και θεραπείες με παλμικό φως.
- Microneedling.
- Μεσοθεραπεία με λευκαντικούς παράγοντες (τρανεξαμικό οξύ, γλουταθειόνη, αρβουτίνη).
- Μικροδερμοαπόξεση.
- Sun protection: Daily use of high-SPF sunscreen is essential. Sun exposure is the most significant aggravating factor.
Despite the effectiveness of the above, relapses are common, making ongoing prevention and maintenance essential.
Examples of therapeutic options
To better illustrate the variety of approaches, here are three cases:
- Melasma during pregnancy: Strict photoprotection and mild topical creams are applied, avoiding pharmaceutical products that are contraindicated.
- Professional sun exposure: A combination of topical therapy with laser is recommended, always with enhanced protection from radiation.
- Persistent melasma despite the use of creams: Chemical peeling and maintenance with antioxidant creams for long-term control.
Prevention and lifestyle
The prevention is the cornerstone in the management of melasma. The measures include:
- Daily application of sunscreen with SPF ≥ 30.
- Avoid sun exposure during peak hours.
- Use a hat and sunglasses.
- Choose cosmetics without irritating ingredients.
Consistency in the above habits significantly reduces the likelihood of recurrence and helps maintain a more even skin tone.
Psychological impact
Although melasma does not cause physical problems, its impact on psychology can be significant. The spots on the face affect one’s self-image and often lead to a decrease in self-esteem. Psychological support and counseling by a specialist can help with the better management of the emotions that accompany the condition.
Melasma is a common yet complex dermatological condition. Understanding its causes, obtaining an accurate diagnosis, and following an individualized therapeutic approach are of crucial importance for its successful management. Despite the challenges it presents, prevention with proper sun protection and adherence to the dermatologist’s instructions lead to satisfactory results and improvement in quality of life.
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