Melasma is a relatively common skin condition among women. It also affects a small population of men. Let’s discover the causes of this unsightly and particularly difficult-to-treat condition.
Melasma: A Form of Hyperpigmentation
The word melasma comes from the ancient Greek "melas," meaning black. Melasma is a hyperpigmentation of the skin characterized by the presence of diffuse patches, most often on the face (cheeks, forehead, upper lip, chin), but it can also affect parts of the body frequently exposed to the sun, such as the neck and arms.
What are the Causes of Melasma?
1) Pregnancy
In its most classic form, melasma or the pregnancy mask appears in women during or after pregnancy. This overproduction of melanin is due to hormonal variations the female body undergoes during and after pregnancy. Estrogen and progesterone levels generally increase sharply during pregnancy; this increase has a direct effect on melanin production and the skin's sensitivity to pigmentation.
2) Birth Control Pills
Contrary to popular belief, melasma is not only triggered by pregnancy. Simply taking contraceptive pills can cause melasma to appear in some women. Much like pregnancy affects the production of female hormones, the contraceptive pill can act directly on melanin production via the resulting increase in estrogen levels. The effect then becomes the same as during or after pregnancy: the rise in estrogen triggers a melanin overproduction, causing melasma to appear.
3) Genetic Predisposition
Melasma is considered a hereditary condition. People who have parents or ancestors affected by melasma are more likely to be affected by the condition themselves. Furthermore, individuals with darker phototypes are often hit by the problem. Since the skin is already prone to variations in melanin production, melasma is quickly triggered if this melanin production is not stabilized.
4) The sun
The sun is both a triggering and aggravating factor for melasma, particularly when exposure is coupled with significant hormonal variations. Repeated and intense exposure to UV rays stimulates excess melanin production, which causes hyperpigmentation.
What are the Specific Types of Melasma and How Do They Manifest?
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Dermal Melasma: This is a deep form of melasma. It forms in the inner layers of the epidermis (generally the basal layer) and manifests on the skin's surface as a bluish-tinted pigmentation. This type of melasma is the most difficult to treat.
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Epidermal Melasma: Epidermal melasma is the most superficial form of melasma, characterized by more or less diffuse patches at the epidermal level. The pigment is generally brown in color.
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Mixed Melasma: Mixed melasma is a combination of epidermal and dermal melasma. The resulting pigmentation is brown and gray in color.
To treat melasma effectively, it is necessary to accurately determine its type and causes. An article published in the JAAD (Journal of the American Academy of Dermatology) emphasizes the importance of science in choosing melasma treatments:
"Given the chronicity of the disease and its well-established psychosocial and emotional impacts, it is essential to ensure that the care provided is based on the best available scientific data regarding the treatment of patients with melasma."
Dark Phototypes and Melasma
Melasma affects people with olive to dark skin more frequently due to the larger amount of melanin they produce. Dark phototypes are naturally more prone to variations in melanin production. Consequently, melasma is a very frequent skin condition for these types and is extremely difficult to treat and stabilize.
