What is melasma?
Melasma is a chronic, benign hyperpigmentation of the skin, which usually occurs on sun exposed areas of the face. The specific condition is called hypermelanosis, meaning that the cells that produce pigment are hyperactive and produce too much pigment. Melasma is caused by many factors, the main factors being hormones, sun exposure, and heat exposure/ redness of the skin. Melasma has many patterns, appearing most prominently on both cheeks, or on the cheeks, forehead, and upper lip as large patches of flat brown pigment with an irregular sometimes jagged border. Melasma is also more prevalent in races with lightly colored skin: Asians and those of Hispanic/Latin descent who live in warm climates are more susceptible to melasma. People often say they feel like their face is "dirty" because of the unwanted pigment; melasma is a genuine cosmetic concern for many women, although men are known to have melasma as well.
Melasma can be subclassified into epidermal, dermal, and mixed melasma. In my experience, most people have mixed melasma, wherein the excess pigment sits in both the epidermis and the dermis.
Why does someone get melasma?
As I mentioned above, melasma is caused by many factors, some of which are unknown. We know that hormones, sun exposure, and heat/redness of the skin can make melasma worsen or darken. Genetic predisposition in women of color (Asians/Hispanics) also plays an important role. Many women first get melasma when they are pregnant. This form of melasma, called cholasma is known as "mask of pregnancy." One of the classic signs of hormonally related melasma is pigmentation on the upper lip. Melasma may start as a small area the size of a quarter and can spread to cover the entire face.
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