Melasma, also called ‘chloasma’, is a common skin condition of adults in which light to dark brown or greyish pigmentation develops, mainly on the face. The name comes from melas, the Greek word for black. Although it can affect both genders and any race, it is more common in women and people with darker skin-types who live in sunny climates. Melasma usually becomes more noticeable in the summer and improves during the winter months.It is not an infection, it is not contagious and it is not due to an allergy. Also, it is not cancerous and will not change into skin cancer.
Melasma treatments fall into the following categories, which can be used together:
- Avoiding known trigger factors, such as the oral contraceptive pill or perfumed cosmetics
- Adopting appropriate sun avoidance measures and using sun-blocking creams
- Skin-lightening agents
- Chemical peels, dermabrasion and laser treatment
- Skin camouflage
Skin affected by melasma darkens more than the surrounding skin with exposure to sunlight, so sun-avoidance and sun-protection are important. Broad-spectrum sunscreens, with a high protection SPF (SPF 30 or more) and a high ultraviolet A (UVA) star-rating (4 or 5 UVA stars), should be applied daily throughout the year, and broad-brimmed hats are recommended. In particular, avoidance and protection measures should be employed during the period of most intense sunshine. Sun-beds should not be used.
Skin lightening creams
Certain chemicals can reduce the activity of pigment-forming cells in the skin, and of these, hydroquinone is the most commonly used. Hydroquinone creams may cause irritation, and care must be taken to ensure that they are not used for too long in case they cause excessive skin lightening. Hydroquinone can, very occasionally, cause increased darkening of the skin by a process called ochronosis, especially in very dark-skinned people. Hydroquinone creams can now only be prescribed by doctors.
Azelaic acid and retinoid creams are mainly marketed to treat acne, but can also help melasma.
All these creams can irritate the skin and are therefore sometimes combined with steroid creams. Some skin bleaching creams contain a mixture of these ingredients.
Chemical peels, micro-dermabrasion and laser-treatment
Chemical peels can improve melasma by removing the cells of the epidermis which contain the excess pigment. These techniques should be undertaken by an experienced person as they have the potential to worsen the pigmentation, to make the skin too light or to cause scarring.
Some types of laser also remove the outer layer of skin, whereas others specifically target the pigment-producing cells. At present, the success of laser treatment is variable, and the possible side effects can be similar to peels and micro-dermabrasion.
These treatments are usually not available as NHS procedures.
Skin camouflage is a special make-up, which is matched to the skin colour of the individual and which will not easily come off. Your general practitioner or dermatologist may refer you to somebody with skin camouflage experience to assist you in finding the right product and to teach you how to apply it. This service is provided by Changing Faces, Skin Camouflage Services and individual practitioners.