Other names: Chloasma; Mask of pregnancy; Pregnancy mask
Melasma is a synonymous term sometimes used to describe the occurrence of melasma during pregnancy. Chloasma is derived from the Greek word chloazein, meaning "to be green." Melas, also Greek, means "black." Since the pigmentation is never green in appearance, melasma is the preferred term.
Melasma has been considered to arise from pregnancy, oral contraceptives, endocrine dysfunction, genetic factors, medications, nutritional deficiency, hepatic dysfunction, and other factors. The majority of cases appear to be related to pregnancy or oral contraceptives. The infrequency of melasma in postmenopausal women on estrogen replacement suggests that estrogen alone is not the cause. In more recent experience, combination treatment using estrogen plus progestational agents is being used in postmenopausal women, and melasma is being observed in some of these older women who did not have melasma during their pregnancies. Sun exposure would appear to be a stimulating factor in predisposed individuals. Although a few cases within families have been described, melasma should not be considered a hereditary disorder.
The areas most commonly affected are the cheeks, forehead, upper lip, and chin. Different types of melasma occur depending on the location of the excess melanin, in the epidermis or the dermis. Melasma is thought to be caused by elevated levels of estrogen, progesterone, and melanocyte-stimulating hormone (a hormone that causes melanin cells to make more melanin).
A combination of tretinoin cream and a bleaching cream containing hydroquinone may be helpful in fading some types of melasma. Occasionally, your physician may add chemical peels or topical steroid creams as well. In severe cases, laser treatments can be used to remove the dark pigment.
Most importantly, however, sun avoidance and daily sunscreen use are key to avoiding melasma.
Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles.
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