Melasma is a pigmentation disorder that causes light to dark brown patches to appear on the cheeks, forehead, nose, upper lip or chin. It most often occurs in women in the reproductive period, and in about 10% of men. It appears only on the body parts that are exposed to sunlight. Triggering factors for its appearance, apart from UV radiation, can be: contraceptives, pregnancy or some anticonvulsants.

What causes melasma?

The cause of melasma is not entirely known. A hormonal imbalance can be a trigger for the disease, in case there is a genetic predisposition. Melasma often occurs during pregnancy or during contraceptive therapy. However, hormone replacement therapy taken at menopause will not cause melasma to appear. Melasma is a chronic disease that worsens after sun exposure, but also if the skin is exposed to a strong spotlight. In people with darker skin, every skin irritation or injury can lead to pigment accumulation. If it is caused by pregnancy or hormonal imbalance, the condition resolves very slowly after a baby is born.

What types of melasma exist?

Melasma is caused by the abnormal accumulation of melanin in the skin. Depending on the skin layer where the pigment accumulates, we can distinguish: – epidermal melasma of light brown colour is caused by excessive melanin levels in the epidermis. – dermal melisma of blue-grey colour have melanin located in the cells in the superficial dermis. – mixed melasma of brown-grey colour have epidermal and dermal components combined. The diagnosis of melasma is made by a simple skin examination.

How is melasma treated?

In the treatment of melasma, the most important thing is the daily use of creams with protective UV factors. Creams must have UVA and UVB protection, as well as visible light protection, with SPF 50+. To lighten the skin and fade away dark spots, it is enough to use creams containing hydroquinone, azelaic acid, retinoids, rucinol. These substances reduce the activity of pigment producing cells and they should be used for at least 3 months. For dermal and mixed melasmas, we use chemical peels and laser treatments. Chemical peels give good results in removing stains, but they should be carried out with caution because of the possibility of triggering reactive hyperpigmentation. Laser removal of melasma is efficiently performed using Q-switch laser, with lower operating energies, in order to avoid irritation and pigmentation worsening. More information about melasma treatment using Vbeam laser you can find here. Treatments are performed during the winter, with strict sun protection.
Svetlana Đurišić specijalista dermatovenerologije

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