Melasma is a condition that belongs to the group of hyperpigmentation disorders. Our pigment is called melanin and is produced by a highly specialised cell in the skin called melanocyte. These melanocytes produce melanin through an enzymatic step requiring some essential amino acids and enzymes to convert the Tyrosine enzyme into melanin. Once melanin is formed it is then stored in packets of small structures called melanosomes which are then transported by the melanocytes to neighbouring skin cells which are called keratinocytes. The amount of melanin present in the keratinocytes gives the skin colour we have. The more melanin we have the darker the skin.
Melasma is a hyperpigmentation condition whereby there is excess production of melanin which is then transported to the skin cells. It is a clinical diagnosis which typically presents with dark patches on the face, most notably on the forehead, cheeks and upper lip. The condition is chronic and relapsing meaning there is no long-term definitive cure and may appear at any point in time. The best way to manage melasma is by taking preventative measures once the condition is under control.
Melasma tends to affect women more than men and its pathophysiology is complex involving factors such as ultraviolet light, hormones, active melanocytes and some other changes in the skin matrix such as the basement membrane and small blood vessels. Melasma is not contagious and not genetic although in some cases there may be a familial tendency. It can also appear during states of hormonal changes such as women taking the contraceptive pills and during pregnancy.
The treatment of melasma involves strict measures to protect against ultraviolet light such as the use of high factor sunscreen and a hat where appropriate and avoidance of sunlight wherever possible. Active treatment for the hyperpigmentation includes topical lightening creams for a minimum of 3 months together with chemical peels or lasers depending on the extent and severity of the melasma. In resistant or severe cases of melasma a tablet treatment can be given which is called tranexamic acid but this needs to be prescribed by an experienced dermatologist and only following strict consideration. Lightening creams remain the first-line and most commonly used method of treatment in melasma.
Dr. Firas Al-Niaimi has published on hyperpigmentation and on oral tranexamic acid and these articles can be found on the publication section of the website.