The World of Pregnancy

Melasma (Mask Of Pregnancy): What Is Chloasma & What Causes It?

Have you heard of the terms chloasma or melasma? Even if you didn`t, it`s never too late, and it`s never a better time to know something as important like this than now.

What Is Melasma

What Is Melasma?

Melasma is the generic name for non-regular, sometimes confluent, symmetrical yellow-brown-gray, spots on the forehead, chin and cheeks.

Chloasma is a photosensitivity reaction which occurs in women who take combined oral contraceptives or in pregnant women (mask of pregnancy), and very rarely occurs in men. Usually, it can be prevented by using sunscreen creams.

Chloasma derives from the Greek word “chloazein,” which means “being green.” “Molasses” in Greek means “black” as well. Because skin coloration isn`t green, the term melasma is preferred.

Dark, irregular spots on the skin occur usually on the both sides of the face. Pigmentation occurs frequently in the center of the face and on cheeks, upper lip, nose and forehead. Sometimes spots can be found on only one single face side. Stains aren`t pruritic or painful and have only cosmetic importance.

Causes of Melasma

The brown spots are caused by an increased content of melanin in the skin. The exact cause isn`t known to increase the amount of melanin. Researchers believe that the causes are associated with the hormone levels of estrogen and progesterone.

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The pathophysiology of chloasma is somehow uncertain. In a lot of cases, there seems to be a direct link between the female hormonal activity as the medical condition occurs in pregnancy and oral contraceptives. Other factors involved in male etiopathogenesis are photosensitising drugs, mild thyroid dysfunction or some cosmetics. The most essential factor in the development of melasma is sunlight exposure. Without the strict sunlight being avoided, the potential success of chloasma treatments is doomed to failure.

Predisposition of Genetics

It`s a major factor in the development of pregnancy mask. It`s more common in women than in men. Persons with light brown skin in areas of the world with intense exposure to sunlight are more prone to develop chloasma. Over 30% of patients have a family history.

Exposure the Sunlight

Another major factor is sun exposure. Ultraviolet radiation might cause lipid peroxidation in cell membranes leading to excessive generation of free radicals which stimulate melanocytes to produce melanin in excess. Protective SPF creams which specifically block UV-B are unsatisfactory because UV-A and visible light also simulate melanocytes to produce melanin. – Click here!

Hormonal Influences

Chloasma is common among obstetric patients. The exact mechanism by which pregnancy affects melasma is unknown. Estrogen, progesterone and stimulant melanocytic hormone (MSH) are normally elevated in the third trimester of pregnancy. Still, nulliparous patients with the mask of pregnancy don`t have elevated levels of MSH and estrogen. Additionally, the incidence of chloasma in progesterone and estrogen contraceptives and diethylstilbestrol treatment for prostate cancer has been reported. The observation that postmenopausal women receiving progesterone develop melasma while those receiving only estrogen don`t require progesterone to play an essential role in the development of the pregnancy mask.

Risk Factors

These risk factors include:

  • Women of reproductive age.
  • Tanned skin.
  • Pregnancy.
  • Prolonged exposure to the sun.
  • Contraception.
  • Using products which irritate the skin, like cosmetics.
  • Taking certain drugs, like anticonvulsant medications or hormone replacement therapy.
  • Family history of chloasma.

Symptoms

The only sign of melasma involves dark spots on the skin that aren`t painful. However, not all the brown spots on the skin are melasma. When you notice such spots, it`s best to consult a doctor.

Diagnosis

Any person of any race might be affected. However, it`s more common in dark, light brown, Asian or Hispanic races – areas exposed to the sun more. Chloasma is much more common in women than men, them being affected in 90% of cases. When men are affected, the clinical and histological picture is the same. Melasma is rare before puberty and occurs more often in women during reproductive life.

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Patients might present melasma after prolonged oral contraception and pregnancy. Intense or chronic exposure to the sun worsens this medical condition and might precipitate it, but due to the often insidious pigmentation development, patients might not recognize the association.

Physical Examination

Macular hyperpigmentation of the melasma is bronze-brown. Blue or black might be obvious in patients with dermal melasma. The distribution is centrophic, malaria or nadibular. It can also be seen on the arms of women who are treated with oxogenous progesterone. Any melanin in excess can be visualized in the dermis or epidermis by a Wood lamp.

The epidermal pigment is revealed during physical examination with the Wood lamp, while the dermal pigment isn`t. Clinically, a large amount of dermal melanin is suspected if hyperpigmentation is blue-black. In people with black-brown skin examination with the Wood lamp doesn`t located the pigment and these patients are classified as undetermined.

Histological Examination

Melanin is raised in the epidermis, dermis or more often in both locations. Epidermal melanin is found in keratinocytes in the basal and suprabasal area. In most situations, the number of melanocytes isn`t increased, although there are quite large, more active and dendritic. Dermal melanin is found in the superficial and profound dermis with macrophages that often agglomerate around small, dilated vessels. Inflammation is absent.

Treatment

Melasma might disappear by itself. If it doesn`t pass on its own, maybe it can be treated. Generally speaking, getting rid of chloasma can be a difficult process. Talk to your doctor about the best methods of treatment.

The melasma pigment develops gradually and the resolution is still gradual. Resistant cases of recurrence occur and are common if sunlight isn`t maintained. All wavelengths of solar radiation, including those in the visible spectrum, are capable of inducing melasma. – Click for more!

Fast methods, like cryotherapy, deep chemical peels, lasers, have poor results and are often associated with a number of side effects that include epidermal necrosis, hpertrophic scars or post-inflammatory hyperpigmentation. The precise manner in which these ways can be used hasn`t been accurately studies. However, they can be safe and effective when performed by experienced doctors, and they can produce faster results than topical ones.

Drugs for Skin Depigmentation

Some medications, like whitening creams, are used to lighten the color of the skin. It`s also possible to use other creams – tretinoin, corticosteroids, glycolic acid, azelaic acid – to open the skin color.

Your skin may be sensitive to these drugs. Be careful when you start using them. The effectiveness of these creams can last for several months.

Other Treatments

Sometimes, other procedures are used to remove the outer layers of the skin:

  • Chemical peeling.
  • Microdermabrasion – eliminates the upper layer of the skin.
  • Laser therapy.

In an attempt to rush the resolution, a lot of practitioners try light exfoliation with superficial chemical peels. The rationale is as follows: if melanogenesis is inhibited by whitening agents and the keratinocy turnover is increased, the resolution time might be low. There are several studies that show that treating melasma with chemical peels and a depigmentation agent is efficient and safe.

Moreover, it`s recommended to avoid using products that can irritate the skin – makeup, cleaning lotions, etc.

How to Prevent Melasma?

To prevent the occurrence of the mask of pregnancy, you should avoid your exposure to sunlight. Apply a full solar screen throughout pregnancy. You may also try sunscreen cream with beeswax. You can use a very large birch hat as well.

When chloasma occurs during pregnancy, it then disappears after 6 months from birth. If it persists, you should consult a dermatologist, who will prescribe a depigmenting cream suited for your skin.

After birth, you should avoid taking a contraceptive pill based on estrogen. Once the skin has depigmented, you should choose another method of contraception or a birth control pill which contains only progestin.

The risk of recurrence of pregnancy mask is quite high in case of a future pregnancy. This is why high sun protection is recommended.

Image courtesy of fairviewcosmeticsurgery.com
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