Is melasma dangerous?

Melasma is a skin condition that causes patches of discoloration, mostly on the bony parts of the face. Although it isn’t dangerous, it can have a huge impact on the way a woman feels about her appearance which can, in turn, affect her overall well-being. Esteemed London-based dermatologist Dr Mary Sommerlad shares her expertise on the condition, explaining how it occurs, who it affects, the treatment options, and why it is more common in women than in men. 

What is melasma and is it dangerous?

Melasma is a skin condition that predominantly affects the forehead and cheeks usually of women of child-bearing age so from the teens to the thirties. It's often seen after a woman has had a pregnancy, but it can also occur with hormonal contraception. There's an increase in pigment in these bony prominences and this pigmentation will contrast with the natural skin colour causing a darkened appearance.  Although melasma does not shorten your life expectancy and shouldn't cause you any pain, it can be incredibly distressing because it changes the appearance of your skin. This burden of distress can have a knock-on effect on the quality of your life. 

What causes melasma?

Melasma is considered to be a really complex interplay between the sunlight, the genetic predisposition, and female hormones, particularly progesterone but oestrogen can also play a part. The current understanding is there's an increase in female hormone and this relationship with visible light from the sun causes a patterned increase in pigmentation usually over the bony prominences of the face, so forehead and cheeks.

What are the treatment options for melasma?

The treatment of melasma is quite complex but essentially boils down to two areas. The most important and number one thing to do is to protect the skin from tanning. This means avoiding sunbathing, avoiding anything that can tan the skin, and protecting from sun tanning. Using sunscreen that blocks visible light, as well as physical sun protectants such as wide-brimmed hats and sunglasses, are crucial. That's the number one thing that you can do to improve the appearance of melasma. 
Next as dermatologists, we discuss the induction of remission of the melasma and then the maintenance of that remission of melasma. In order to induce remission, we usually recommend using topical treatments that reduce the hyperpigmentation in the skin and there are a variety of different ways of using these different ingredients. These ingredients can often be quite irritating and often not to be used as long-term, non-stop treatments. We normally induce remission over a period of four to six weeks and then you need to try and maintain the remission and that's using non-irritant topical treatments to try and prevent the increase in pigment from coming back. 
As we learn more about this condition, there are more different treatments available. Now there are also treatments that can be taken orally as well as laser therapy. Although popular, it's important to note that this laser therapy must be performed by people who have familiarity in treating melasma in a wide range of different skin tones. Always ask laser therapists if they're familiar with how to treat your skin tone and your type of melasma. Although there isn't a cure for melasma, it can be well managed so it doesn't affect the quality of your life.

How can melasma be treated on the face?

You can manage melasma on the face first of all by using your sunscreen that prevents visible light from getting through. You can also use topical preparations and oral preparations that can help reduce the increase in pigmentation on the face. Then there are also treatments that we would recommend to use long term to try and reduce pigment from coming back. In terms of lifestyle, if you're using hormonal contraception, it may be worth looking for non-hormonal contraception to see if that can help the appearance of your melasma. I also recommend my patients with melasma try camouflage, which includes using certain types of makeups concealers foundations that can help improve the appearance of the melasma on the skin.

Can melasma be cured permanently? Why or why not?

At present time there is not a permanent cure for melasma. However, many people do find that with time and with age their melasma may improve spontaneously on its own. A lot of people also find that their melasma improves with treatments and using sunscreen diligently all year round, including in the winter. If you notice that your melasma was really triggered by pregnancy, the more time that passes after having the baby, there may also be a gradual improvement in the appearance of melasma. For many people with melasma, it can gradually improve as time passes, for a small minority they may find that their melasma is something that's very difficult to find improvement without active treatment being used in bursts.

Do men or women get melasma more often? Why?

Melasma is overwhelmingly a condition of women of child-bearing years, so mid-teens until about mid-40s. We believe this is because melasma is triggered by a complex interplay between female hormones, the sun, and pigment cells known as melanocytes. However, we do have cases of men who develop melasma. Although it is predominantly seen in women, any men who notice an increase in pigmentation particularly over the forehead and cheeks should have an assessment with a dermatologist to determine the cause. 

If you would like to book a consultation with Dr Mary Sommerlad to discuss a suspected skin condition, you can book one directly on her Top Doctors profile.