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Melasma, also known as chloasma, is a common and frustrating skin condition. It presents as symmetrical, blotchy brown to gray-brown patches, most commonly on the face and neck. Melasma affects more than 5 million people in the United States, alone (1). Found more commonly in women with darker skin tones, it is especially prevalent in those of Hispanic, Southeast Asian, African, Indian, Mediterranean, and Middle Eastern backgrounds (2). People living in areas of intense ultraviolet (UV) light, like the Gulf Coast of Florida, are at higher risk for melasma. Although melasma is not harmful, it is often a challenge to treat and can hurt quality of life.

Melasma is caused by increased activity in the pigment-producing cells of the skin called melanocytes, resulting in more pigment deposition. The exact cause of melasma is unclear. However, a common causative factor is exposure to sunlight, which is thought to activate the melanocytes to produce more pigment.

Hormones are also thought to play a role, but the exact link between hormones and melasma has not been clarified. Nevertheless, circumstances that affect hormones, like pregnancy, oral contraceptives, and hormone replacement therapy can contribute to the development of melasma. Less common risk factors include thyroid disorders, phototoxic medications (medications that cause skin reactions in sunlight), and cosmetics.

Melasma often requires a combination of treatments to produce results. Improvement occurs over several months. Reducing exposure to sunlight and applying sunscreen daily is a critical step. When outside, avoiding direct sunlight by wearing a wide-brim hat or other protective clothing is more effective than sunscreen alone. You should use a high-factor broad-spectrum sunscreen that protects against Ultraviolet A light. Ultraviolet (UV) A light is a form of non-ionizing radiation that is emitted by the sun and artificial sources, such as tanning beds.

Various treatments are available for managing pigmentation issues. To enhance the removal of existing pigment, topical retinoids and glycolic acid peels can be effective. For depigmenting or lightening, agents such as azelaic acid or hydroquinone are beneficial, and often used in combination with a retinoid and a topical steroid. Other topical alternatives include kojic acid and niacinamide.

Tranexamic acid, available in topical or oral forms, helps prevent the activation of melanocyte-stimulating factors. In cases of melasma triggered by oral contraceptives, discontinuing the medication can be helpful if feasible. Melasma related to pregnancy may improve after childbirth.

Laser therapy may also be a suitable option to treat your melasma. Treating melasma effectively usually involves a combination of therapies. Because your needs are unique, a visit to a board-certified dermatologist, such as those at Bliss Dermatology, is recommended to identify the most suitable treatment options.

Schedule a dermatology appointment today.

During your dermatology consultation, board-certified dermatologist Dr. Michelle Pennie will discuss your concerns and the best treatments for your specific condition and lifestyle. Bliss Dermatology specializes in diagnosing and treating melasma. Bliss Dermatology is proud to be regarded as one of the best dermatology practices on the Gulf Coast of Florida, with offices in Venice and Englewood. Schedule a consultation today.

At a Glance

Michelle Pennie, MD

  • Board-Certified Dermatologist
  • Fellowship-Trained Mohs Surgeon
  • Founder and Lead Dermatologist of Bliss Dermatology
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