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General Description

Melasma is a condition that presents as mottled brownish patches on the face. The most common sites are the cheeks, nasal bridge, forehead, and upper lip. The condition invariably affects women and is most common in more dark skinned ethnic groups such as Asians, Indians, and Hispanics. Melasma is believed to affect some six million women in the United States.

Causes

Several factors play a role in the development of melasma, including a hereditary predisposition. Hormonal changes are also implicated. Melasma occurring in pregnant females is referred to as chloasma (or “the mask of pregnancy”). Melasma may be induced or worsened by both birth control pills and exposure to sunlight.

Medical Treatments

Treatment of melasma is difficult. If the condition is related to pregnancy, gradual resolution may follow delivery. If the condition began while the woman was on birth control pills, discontinuation is often advised.

Protection from ultraviolet light is essential, and this should involve sun avoidance and sun protection utilizing daily application of a broad-spectrum sunscreen, the higher the SPF the better. This is important as window glass does not block out ultraviolet radiation of the A range.

Some cases of melasma will respond to a combination of sun protection and over-the-counter bleach creams, the latter usually containing low concentration of the agent hydroquinone (Eldoquin, Esoterica, Porcelana). Higher concentrations (greater than 2 percent) are available by prescription only (Claripel, Eldoquin Forte, Lustra). Hydroquinone inhibits an enzyme responsible for the production of melanin. Use of hydroquinone is somewhat controversial; in 2006 the FDA proposed banning this product from over-the-counter preparations in response to animal studies linking it to an increased risk of cancer.

Tri-Luma is a particularly effective topical agent. This prescription cream combines hydroquinone, a topical steroid, and tretinoin. Azelaic acid (Azelex, Finacea), tazarotene (Tazorac), adapalene (Differin), and glycolic acids also have skin-lightening properties. No matter what agent is chosen, response is slow, requiring a minimum of three months of therapy. Microdermabrasion may enhance the efficacy of topical agents. Lasers and chemical peels may prove of value but may also induce increased pigmentation.

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