What is melasma?
Melasma (also called chloasma or the “mask of pregnancy”) is a brown discolouration of the face and sometimes also of the neck. The discolouration usually develops slowly and arises without any preceding inflammation of the skin. The most typically affected areas are the forehead, the skin over the cheekbones, the upper lip and the chin. Melasma is a harmless form of hyperpigmentation.
Who gets melasma?
The condition typically occurs in pregnant women, hence the term “mask of pregnancy”. Women can develop the discolouration especially in the second and third trimester. In general the melasma gradually disappears again after childbirth. In subsequent pregnancies the discolouration usually returns, and not infrequently darker than in the previous pregnancy. Women who have a predisposition to melasma and use the contraceptive pill can also develop the typical facial discolouration. Sometimes melasma is seen without pregnancy or use of the pill.
How is melasma treated?
As mentioned, in most women the discolouration disappears by itself after pregnancy. By avoiding exposure to sunlight this natural process can take place undisturbed. Sometimes, however, some pigmentation remains. When treatment is chosen, it should be after pregnancy, and options include:
Hydroquinone-containing cream. Hydroquinone “bleaches” the skin with regular application. Hypersensitivity to hydroquinone does occur, and caution is needed because the treatment can sometimes “overshoot”, bleaching the skin too much. Hydroquinone preparations can be prescribed by your doctor, and the hydroquinone can if necessary be combined in one cream with tretinoin.
Laser therapy. Laser therapy can give good results; the ruby laser in particular is often effective in removing the pigment. As with cream treatment, it is unfortunately possible for the pigmentation to return after exposure to sunlight.
How is it prevented?
Women with a predisposition to melasma would be wise to limit exposure to sunlight during pregnancy (and in the months afterwards), using good sun protection.
When to see a doctor
Melasma is harmless, but see your GP or a dermatologist if the discolouration persists after pregnancy and bothers you, if you are unsure whether a brown patch is melasma or something else, or before starting bleaching creams — these need medical guidance to avoid over-bleaching or irritation. Any single spot that grows, changes shape or has an irregular colour should be assessed separately.