The Causes And Treatment Options For Melasma

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Melasma is a benign condition where dark patches of discoloration form on skin that is exposed to the sun. This pigmentation is caused by excessive levels of melanin.

Melasma occurs more commonly in women, especially during pregnancy. For this reason, it is referred to as the “mask of pregnancy.”

It is important to understand the causal processes involved behind the scenes, so to speak. There are many treatment options available. However without the right level of understanding, it would be difficult to determine which ones make sense.


Like many other skin issues, melasma is caused by a genetic predisposition. In other words, instances of the condition often run in families. Also with identical twins, the occurrence of brown macules will occur in both siblings.

This genetic predisposition governs the physiological conditions that dictate the way skin responds to sun exposure.

Fluctuations in the levels of estrogen and progesterone, for example are concurrent with the manifestation of melasmic macules.

Melanin comes from specialized structures within skin cells called meloncytes. They become extremely active when the skin is exposed to the sun and produce high concentrations of melanin.


Because melasma is a pigment disorder, it is important for treatments to address the condition at the level of melanin, present in the epidermis and the dermis.

Hydroquinone is a topical cream, available by prescription, that decreases the activity of the biochemical process involved in producing the melanin. The standard concentration of effectiveness is 2-4%.

Cosmetic lasers can also address melasma by eradicating the structures within the skin cells containing the melanin. Examples include Fraxel Dual and Nd:YAG 1064 laser.

Intense Pulse Light is not considered to be a laser. Lasers use a single color or wavelength. IPL, on the other hand uses multiple wavelengths which also targets the melanosomes in the same way that lasers do. Because IPL is not a laser, it cannot reach the dermal layer below the skin’s surface. So it is only useful when the melanosomes are present in the epidermis.


Melasma occurs predominantly in women of all ethnicities. Although it may seem similar to freckles, melasma has a direct relationship to hormone levels. And while freckles are seen in individuals with fair skin, melasma is common among women with light brown skin tones. In addition to topical and treatments using lasers and light, it is important for individuals to use sunscreen, rated at 30+ SPF that protect against UVA and UVB radiation.

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