Melasma is a very common skin condition that I encounter in both my The Woodlands dermatology and Conroe dermatology offices. Melasma results from excess production of melanin (pigment) in the skin. Melasma is induced by UV interaction with the skin so strict sun protection is essential in preventing and treating Melasma. Both broad brimmed hats and sunscreens protecting against both UVA and UVB at an SPF of 30 are necessary. Women are more prone to the development of Melasma and there is a strong association between hormones making a patient more prone to developing this condition. Oral contraceptives, pregnancy and photosensitive medications have been implicated in inducing Melasma and the term “mask of pregnancy” has been applied to this condition. Men can also develop Melasma as there is a genetic component associated with this skin disorder. Melasma is much easier to treat if the melanin is confined to the epidermis (top layer of skin). If the melanin is deeper in the dermis (second layer of skin), it is very treatment resistant. A Wood’s Lamp can be used to determine the level of melanin as it enhances epidermal and not dermal pigment. Treatment involves strict sun protection and in most patients the use of a bleaching agent. In my clinic, I typically prescribe a compounded mixture of Hydroquinone 4%/ tretinoin .025% / hydrocortisone 1% to be used nightly on the dark areas for approximately three months or less if the hyperpigmentation disappears sooner. Lasers can also be used to treat the Melasma.
