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Melasma is basically a
skin discoloration which is often associated with pregnancy. Melasma
is also called the mask of pregnancy because of its association with
pregnancy. Melasma appears as a tan discoloration on the face of the
affected person. It is particularly common in women especially in
pregnant women. The usage of oral contraceptives or hormone
replacement therapy (HRT) medications can make you more vulnerable to
this disease. Melasma is common in both men and women of North
American origin and they develop it mainly in their fore arms, it is
also common in both sexes of German and Russian Jewish origin.
Melasma is formed due to the action of the human coloring pigment
called melanin. Melanin is responsible for the dark coloration of the
skin and if melanin production in any particular area exceeds other
areas around it, that particular area becomes darker. Melanin is
produced by the melanocytes which are present in the epidermal layer
of the skin. These melanocytes produce melanin when they get
stimulated by a hormone called melanocyte-stimulating hormone. Female
sex hormones estrogen and progesterone can stimulate the production of
melanin pigments when the skin is exposed to sun. This means the
addition of more melanin to the skin. Women with a light brown skin
type who are living in regions with intense sun exposure are
particularly susceptible to developing this condition.
Some scientists believe that stress can cause the over production of
melanocyte-stimulating hormone and can thereby cause the outbreak of
Melasma in stresses people. Some also believe that certain gene
combination can produce this condition. The incidence of melasma also
increases in patients with thyroid disease.
Melasma Suprarenale is a symptom of Addison's disease, particularly
when caused by pressure or minor injury to the skin, as discovered by
Dr. FJJ Schmidt of Rotterdam in 1859.
Melasma can be easily diagnosed because in most cases it is clearly
visible on the skin and can be observed without the help of any
specialized device. Medically it is diagnosed with the assistance of a
wood lamp of 400 nm wavelength. Under the wood lamp it is very easy to
identify areas where excess melanin is produced.
It is important for the patient to understand that Melasma does not
cause any other symptoms beyond the cosmetic discoloration. It
generally appears as dark, irregular patches on cheeks, lip and other
areas on the face.
The dark patches formed as a result of melasma are not permanent and
it generally disappears after several months after the delivery period
or stopping the oral contraceptives or hormone replacement therapy.
Special treatments are not mandatory in the case of melasma. But there
are few treatments that can be done to hasten the disappearance of the
dark patches. Usage of tyrosinase inhibiting chemicals is a good
method. Tyrosinase is an enzyme which plays a major role in the
production of melanin. Chemical hydroquinone is a good tyrosinase
inhibitor and it can be used in 2% and 4% concentration.
Another chemical used is Azelaic acid which inhibits the action of
melanocytes. This can be used in the concentration of 20%.
An acid known as tretinonin is also used which has got the capacity to
increase the skin cell turnover. This treatment cannot be used during
pregnancy.
Facial treatment with chemicals like alpha hydroxyacids and glycolic
acid is also used to make the dark spot disappear faster.
Laser treatment can also be used. But before the laser treatment it is
important to determine if the patches are of epidermal or dermal in
origin because if they are dermal in origin, the laser treatment can
make it darker. Dermal melasma is generally unresponsive to most
treatments.
Even if you do any or all of these treatments it is better not to
expect any magical effects, which means that the results will be
gradual and also it is important to avoid sunlight during the
treatment. And of course you can always use cosmetic cover ups to make
the patches look lighter.
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