Melasma : The mark of Preganancy

Melasma is a common disorder of cutaneous hyperpigmentation predominantly affecting the faces of women, although not uncommon in men. Little is known about the etiology of Melasma. Melasma may be initiated by pregnancy and oral contraception, hence the popular term "mask of pregnancy". Women in whom melasma develop during pregnancy should not be treated until several months after delivery because the dark spots often fade spontaneously. However, avoidance of sun light exposure and daily use of a sunscreen during pregnancy may retard the development of melasma. Melasma is an acquired circumscribed pigmentary disorder characterized by more or less symmetrically distributed, medium to dark brown blemishes with well defined geographic borders, affecting the sun exposed areas, particularly the forehead, cheeks, temples and upper lip.
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What causes Melasma?

The exact etiology is not known, however, the following factors are implicated Sunlight Affection of the sun exposed areas, Exacerbation of the lesion by light Hormonal Association with Oral Contraceptives, pregnancy,endocrine dysfunction. Genetic Occurance of Familial cases Toxic (ingredients in cosmetics). Females more commonly affected Characteristic affection of the face, the part of the body which is frequently exposed to cosmetics drugs Development of a similar type of pigmentation following Hydantoin therapy.

What are the various types of Melasma?
Melasma usually presents itself in one of the three symetrical facial patterns.The most common is a centrofacial pattern involving the cheeks, forehead, upper lip, nose, and chin. Less common are the malar pattern, involving the cheeks and nose, and the mandibular pattern, involvong the ramus of the mandible (the side of the cheeks and jawline). Melasma also occurs on the forearms, but this is rare.
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What is the treatment of Melasma?

Treatment of Melasma includes strict sun avoidance, discontinuation of provocating factors (Oral Contraceptives, hydantoin, cosmetics) and chemical peeling with alpha hydroxy acids (Glycolic Acid).

Sunscreen

Sunscreen is the most important feature of a successful treatment. Without daily use of opaque sunscreen, treatment will fail. A broad-spectrum formulation with an SPF over 30 plus cover up is adequate. Look for sunscreens that contain PARSOL 1789 or avobenzone, Zinc Oxide, and/or Titanium Dioxide. Make sure the formula is sweatproof if you plan on being in the sun for long hours.Normally up to 2 months are required to begin to initiate response and up to 1 year to complete the process.

Hydroquinone

Hydroquinone is the most popular, and is also the most effective topical hypopigmenting agent. Hydroquinone works by inhibiting the conversion of tyrosine to melanin, inhibiting the formation of melanosomes and increase the degredation of melanosomes, and by inhibiting the DNA and RNA synthesis of melanocytes.

Tretinoin

Tretinoin (Retino-A, Renova) is another widely used therapy for Melasma. Tretinoin does have a lightening effect on melasma and can be used alone or in conjunction with HQ. Tretinoin works by promoting the rapid loss of pigment via increased epidermopoiesis, easing penetration of HQ into the skin, and preventing HQ oxidation.

Azelaic Acid

A recent discovery for the treatment of Melasma, can produce good lightening results Azelaic acid would make a good alternative to hydroquinone for continued therapy. A small percentage of patients may, however, experience some itching or burning.

VitaminC

Vitamin C can be combined with other Melasma treatments for enhanced results.

What is Chemical Peeling?

Chemical peeling or chemical exfoliance is application of alpha hydroxy acids (Glycolic Acid) to the skin so as to cause controlled destruction of the epidermis and or dermis.

How is the peeling done?

Initially the affected area is cleaned with isopropyl alcohol & acetone, the glycolic acid is applied with cotton buds,, the acid is left in contact with the skin for 3-5 minutes, a mild frosting develops this is the end point of treatment, the peel is terminated using normal saline. A sunscreen is applied and the patient can resume work.

Is the treatment Painful?

No!! the treatment is painless, only mild burning sensation is experienced during the procedure.
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How many sittings are required?

On an average 4 to 6 sessions are required at monthly intervals to produce significant lightening of the pigmentation.

Are there any special precautions required after the peeling?

Sun avoidance and the usage of broad spectrum sunscreens is mandatory, patients are advised to avoid the use of cosmetics.