Melasma/Chloasma(মেচতা): a common aesthetic problem

It is natural to be worried when any area of skin looks different from other parts of the body.It may be lighter/hypopigmented(as in vitiligo) or darker/hyperpigmented,focal or diffuse in pattern.There are several reasons for darker/hyperpigmented skin condition,such as;
■melasma/chloasma
■thyroid disorder
■excessive deposition of iron
■liver cirrohsis
■addisons disease
■post effects of some inflammatory skin diseases & skin injury
■side effects of some drug
When changes occur in exposed areas(such as face) of skin,the individual tends to suffer from lack of confidence,melasma/chlosma is such a condition.Melasma is not related to any medical disorder and by itself is a harmless skin condition.
Melasma/chloasma is skin discoloration (tan, brown, blue or black) found most commonly on sun-exposed areas of the body. It appears as a blotchy pigmentation that develops slowly and fades with time.Melasma usually affects women; only one in twenty affected individuals are male. It generally starts between the age of 30 and 40. It is more common in people that tan well or have naturally dark skin compared with those who have fair skin. It is quite commonly seen in pregnant women and is often referred to as the “mask of pregnancy”. It presents itself as a dark facial skin rash with irregular borders. The rash is usually recognized by its symmetrical presentation on the cheeks, lips, nose or forehead. Skin discoloration can also occur on the upper arms. The skin discoloration can vary in color ranging from a dark brown to a deep grey.The condition is universal and seen in all cultures and ethnicities; however it is far more commonly seen in Asians, Hispanics, Arabs and North Africans who all seem to have higher levels of melanin in their skin and a tendency to tan. Individuals with fair skin may experience a lighter shade of melasma which is not always recognized.Melasma affects the forehead, cheeks and upper lips resulting in macules (freckle-like spots) and larger patches. Occasionally it spreads to involve the sides of the neck, and a similar condition may affect the shoulders and upper arms.Melasma is sometimes separated into epidermal (skin surface), dermal (deeper) and mixed types.
Process of Melasma formation
It is believed to be due to an increase in the production & deposition of cells which release the pigment melanin, which is responsible for the dark color of the skin.
Causes of melasma/chloasma
What causes the increased production of melanin is not known but some triggers include:
■ Hormone fluctuation/production: the rash is most common in pregnant females
■Prolonged sun exposure
■Use of birth control pills
■Certain medications like tetracycline and anti-malarial drugs (derived from quinine)
■Scented or deodorant soaps, toiletries and cosmetics – a phototoxic reaction
■Unknown factors, when it arises in apparently healthy, normal, non-pregnant women
■Hereditory factor

Symptoms of Melasma/chloasma
Except hyperpigmentation there is no other associated symptoms in melasma.

Treatment & management
Melasma is usually a transient skin disorder that may resolve itself. This may occur after childbirth in pregnant women. In cases where the melasma occurs in men or non-pregnant women, it may exist for a few months to a few years and then suddenly disappear. Thus treatment is not always warranted and it is difficult to know if and when the rash will remain and in whom it will disappear.Over the years, various treatments developed to treat melasma including:
■Chemical peels. The most commonly used acid compounds to remove melasma include trichloroacetic acid, azelaic acid, glycolic acid, lactic acid and various fruit extracts. Stronger peeling agents tend to have a higher effectiveness rate than lighter strength peeling agents. Stronger peeling agents may also carry the risk of side effects such as burning, skin peeling, scarring and even worsening the skin discoloration.
■Skin lightening agents. There are many skin lightening agents on the market and the most commonly used is hydroquinone. Numerous other medication are precribed such as azelic acid,salicylic acid,alpha hydroxy acids,retinoids & steroids may work as skin lightening agents(single or as a combination) as well, however each patient has a unique skin type and reactions & results to skin lightening agents may vary.
■Sunscreens, especially those which are mineral based, such as zinc and titanium.
■Laser skin rejuvenation
These treatments do not necessarily cure the cause of melasma and the effectiveness of each will vary from patient to patient. Even after treatment, skin discoloration may not always disappear completely and each patient may have to try various different treatment options to see a satisfactory result. Some treatments may have to be continually performed to sustain results, such as applying a skin lightening agent on a regular basis, combined with effective sunscreen usage and sun exposure avoidance.To help prevent melasma from worsening, patients may wear sunscreen which contains a mineral based shield from the sun with an SPF at least 20. Protective clothing and wearing a hat may help to prevent melasma from worsening. Protective facial make-up may also be worn to help even skin tone and block out the sun.
Consulting with a local cosmetic dermatologist in your area may offer skin care opportunities for melasma that are right for you.
Writer:
Consultant,Skin,Allergy & Beauty-medicare
Asian General Hospital LtdProgati saroni,South Baridhara,Dhaka
Appointment:9860000,9898899,01711381302