Melasma is a pigmentation disorder of the skin. It can affect both genders but is more common in women. There are two main types of melasma: patchy melasma and spotted melasma, also known as hormonal melasma. Sometimes, clinical cases present with a combination of both types, termed mixed melasma.
1. Hormonal melasma
Hormonal melasma or spotted melasma, arises from hormonal imbalances in the body that lead to the formation of hyperpigmented spots on the skin. Its development is closely tied to estrogen - a vital reproductive hormone. Besides its role in reproduction, estrogen inhibits the production of melanocyte-stimulating hormone (MSH), which triggers melanin production under the skin.
When estrogen levels drop, the inhibition of MSH is reduced, leading to uncontrolled melanin production that surfaces on the skin, forming melasma and other pigmentation issues like freckles and age spots.
Common causes of hormonal imbalance leading to spotted melasma:
- Women in premenopausal or menopausal stages.
- Pregnancy or postpartum periods.
- Use of contraceptives, especially those containing progestin; melasma can develop during or 2-3 months after using the medication.
- Irregular menstrual cycles can sometimes also cause melasma.
- Prolonged stress and tension affecting brain activity will also lead to disorders in the production of estrogen and some other hormones, creating favorable conditions for the formation of melasma.
Clinical features of hormonal melasma:
- Appearance: Dark brown spots that, when examined under a light, reveal concentrated pigment cells in specific areas. The size of the melasma spots is uneven, mixed in size.
- Location: Symmetrically located on both cheeks, but may also appear on the temples, forehead, or arms rarely elsewhere. If untreated, it can spread to adjacent areas.
- Hormonal melasma may accompany symptoms of hormonal imbalances such as menstrual irregularities, sleep disturbances, fatigue, poor appetite, and acne.
- The level of melasma on the skin can warn of endocrine disorders in the body.
Treatment for hormonal melasma: Combine treatment of the cause with treatment of the symptoms.
Treatment of the cause: The main cause of hormonal melasma is a disorder from within the body. Balance hormonal levels through prescribed medications or dietary adjustments under a doctor’s guidance.
Symptom Management:
- Use laser therapy alongside home skincare products to inhibit melanin production, promote healthy cell growth, and improve skin brightness.
- Limit the application of skin peels.
- Adopt a healthy diet, proper rest, and stress management practices.
2. Common Melasma
Unlike hormonal melasma, common melasma primarily results from external factors, especially poor skin care practices. Factors contributing to common melasma:
- Sunlight and blue light containing UV rays trigger the body's natural defense mechanism, leading to increased melanin production in the skin. When the skin is exposed to UV rays, melanocytes release more melanin, which then moves to the skin's surface. This melanin absorbs UV rays, converts their energy, and reduces their harmful effects on the skin. While increased melanin provides better protection, excessive production can lead to skin darkening. This is why unprotected sun exposure can result in melasma.
- Improper skin care, use of poor quality cosmetics, wrong skin care treatments, using too many forms of skin peeling. This is a common phenomenon occurring in many spas from small to large. Hasty treatment, not understanding the root cause of melasma, giving customers peeling cosmetics with high acid content, strong acids and using them continuously many times leads to skin erosion, the skin becomes weak and easily affected by ultraviolet rays, causing melasma or making melasma worse.
- Environmental Pollution: Although not a direct cause, pollution exacerbates existing melasma.
Clinical Features of Common Melasma:
- Appearance: Unlike spotted melasma, common melasma appears as large, irregular patches of pigment spread across the skin. The borders between affected and unaffected areas may be unclear.
- Location: Primarily on the cheeks, forehead, temples, and sometimes arms (less common).
- Common melasma typically does not coincide with hormonal imbalance symptoms. Some combined conditions can still show symptoms of the disorder, but not many.
Treatment for common melasma:
- Combine laser treatments with targeted skincare products that regenerate cells and inhibit melanin production.
- Avoid chemical peels.
- Adjust lifestyle habits, improve skincare routines, and use appropriate cosmetics.
- Sunscreen and nourishing products are essential to strengthen skin resistance.
- Actively protect the skin from sunlight and UV exposure.
Melasma patches or spotted melasma, common melasma or hormonal melasma, although not harmful to health, don’t pose a risk to life, but greatly affect facial aesthetics, creating a feeling of inferiority for the sufferer, especially women. Melasma is not too difficult to treat if you choose the right treatment method and know how to properly care for and protect your skin.
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