How do melasma and chloasma arise?
“What is melasma / chloasma?”
Melasma is a pigmentation disorder of the skin. Melasma is usually seen as darker areas of skin on the forehead or temples of medieval women, much less often in men. The cheeks, forehead, chin, and upper lip are often affected. Melasma and chloasma are two different names for dark spots on women’s faces. The terms are largely used in the same way today. Correctly, however, melasma is only understood to mean the hormonal stains that developed during pregnancy; Chloasma, on the other hand, is the broader term that also includes other types of pigment reproduction in the face. The scientist speaks of acquired “hyperpigmentation” (increased darkening) in the forehead, cheek, and upper lip area of the face.
Female sex hormones (estrogen and progestin effects) and the sun can trigger melasma. Melasma during pregnancy often disappears slowly after delivery. Melasma appears as dark, irregular spots, usually on the forehead or the center of the face, on the cheeks, upper lip, and nose. The brown color is often symmetrical. Melasma on the forearms is rare. The dark spots usually develop slowly, they do not itch or hurt and are harmless. However, the cosmetic impairment can be very stressful for those affected, mostly women of childbearing age.
“Causes of Hormone Spots”
The brown coloring of the skin is mainly caused by melanin pigment; There are two types of it: the reddish pheomelanin and the brownish black eumelanin. Special pigment-forming cells of the skin, so-called melanocytes, produce the pigment and pass it on as melanosomes to the horny cells of the skin. These keratinocytes make up about 90% of the epidermis. They migrate to the surface of the skin and are shed as tiny flakes of skin. In this way, the skin pigments are slowly broken down again. An increased formation of melanin can have different causes. The most common cause of melasma is hormonal. It is believed that pigment-producing cells are stimulated to produce melanin by female sex hormones when the skin is exposed to the sun. The female sex hormones estrogen and progesterone are particularly strongly produced during pregnancy: a brownish “pregnancy mask” can result.
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Estrogen, progesterone and melanocyte-stimulating hormone (MSH) are increased especially in the third trimester of pregnancy. Sunlight will further darken the pigmented areas. The melasma of pregnancy usually fades gradually after delivery. Women taking birth control pills and women on hormone replacement therapy (HRT) going through menopause are also at increased risk. 90% of those affected are women. As almost always, genetic predisposition plays a role: if melasma has already occurred within the family, the risk for other women in the family is increased. Patients with thyroid disease are at greater risk of hyperpigmentation. It is believed that stress-induced overproduction of a certain hormone called melanocyte-stimulating hormone (MSH) can lead to the onset of this disease. Many birthmarks also seem to increase the risk. Intolerance to drugs (phototoxic and photoallergic), chemical substances, cosmetics, perfume or plant saps are less likely to be triggers. A serious illness (adrenal gland disease, tumor, malnutrition) is very rarely the cause of melasma. Melasma is most common in sunny countries, more common in people with darker skin (Latin Americans, Asians). stress-induced overproduction of a certain hormone called melanocyte-stimulating hormone (MSH) can lead to the onset of this disease. Many birthmarks also seem to increase the risk. Intolerance to drugs (phototoxic and photoallergic), chemical substances, cosmetics, perfume or plant saps are less likely to be triggers. A serious illness (adrenal gland disease, tumor, malnutrition) is very rarely the cause of melasma. Melasma is most common in sunny countries, more common in people with darker skin (Latin Americans, Asians). stress-induced overproduction of a certain hormone called melanocyte-stimulating hormone (MSH) can lead to the onset of this disease. Many birthmarks also seem to increase the risk. Intolerance to drugs (phototoxic and photoallergic), chemical substances, cosmetics, perfume or plant saps are less likely to be triggers. A serious illness (adrenal gland disease, tumor, malnutrition) is very rarely the cause of melasma. Melasma is most common in sunny countries, more common in people with darker skin (Latin Americans, Asians). Many birthmarks also seem to increase the risk. Intolerance to drugs (phototoxic and photoallergic), chemical substances, cosmetics, perfume or plant saps are less likely to be triggers. A serious illness (adrenal gland disease, tumor, malnutrition) is very rarely the cause of melasma. Melasma is most common in sunny countries, more common in people with darker skin (Latin Americans, Asians). Many birthmarks also seem to increase the risk. Intolerance to drugs (phototoxic and photoallergic), chemical substances, cosmetics, perfume or plant saps are less likely to be triggers. A serious illness (adrenal gland disease, tumor, malnutrition) is very rarely the cause of melasma. Melasma is most common in sunny countries, more common in people with darker skin (Latin Americans, Asians).
Chloasma is classified according to the triggers as follows:
- Chloasma gravidarum / uterinum (English: mask of pregnancy): arises during pregnancy.2.
- 2. Chloasma hormonale: caused by estrogens (e.g. pill) or estrogen-
- forming tumors. These two first forms are by far the most common forms of chloasma
- 3. Chloasma hepaticum (mask biliaire): due to liver cirrhosis
- 4. Chloasma cosmetogenicum: arises from chemical substances / perfume / plant juices (e.g. Bergapten, 5-MOP)
- 5. Chloasma medicamentosum: arises from drugs such as phenytoin
Other scientists divide melasma into the following subgroups:
Melasma gravidarum / uterinum (English: mask of pregnancy): arises during pregnancy; Melasma hormonale: arises from estrogens (e.g. pill) or estrogen-forming tumors.
Sunlight or solarium always has a reinforcing effect. That is why good sun protection should be the basis of every treatment. The hyperpigmentation can, however, also arise spontaneously for no apparent reason. Similar changes rarely occur in men. Only in very rare cases is a serious illness the cause (e.g. adrenal gland disease, tumor, malnutrition). The affected woman usually notices that the brown color is worse in summer and lighter in winter. Spotty brown discoloration of the facial skin is harmless and therefore does not necessarily need to be treated from a medical point of view. For aesthetic reasons, however, many women want the annoying discoloration to be removed.
“Treatment of melasma: creams, peeling, microdermabrasion, home remedies ….”
Treating melasma is quite difficult, but not impossible. Do not be discouraged. Our treatment strategy is based on several pillars.
Melasma and chloasma can usually be significantly improved or eliminated through the combination treatment described. The basis of every treatment is a strong, daily applied sun protection with an effective protection factor against UVB and UVA. The solarium is absolutely taboo. The lightening of the spots is always slow. A repeated occurrence and untreatable cases are unfortunately relatively common. In order to avoid relapses, consistent sun protection is necessary even after successful treatment. It can take months to see improvement – patience is required. If the melasma was caused by contraception, hormone replacement therapy or other medication, it should be checked whether the pill or medication can be discontinued or replaced by another medication.
REALR Skin Clinic is a Professional skin care in Boston. We have more than 10 years experience with skin problem. REALR Skin Care provides high quality medical and dermatologic care for a variety of conditions. REALR Skin Clinic provide care in a safe, sterile environment with friendly, qualified staff.
Melasma can be treated by laser and Chemical peel, it can also be treated using microneedling, a minor, non-invasive procedure that uses tiny needles to create micro-traumas in the skin. This procedure works to stimulate collagen production and has shown promising results for reducing the appearance of skin hyperpigmentation.
If you have melasma and are seeking treatment, please call our office at 6172088250 to book an appointment.
