Melasma (also known as chloasma or the “mask of pregnancy”) is a skin condition characterized by dark brown, well-demarcated and roughly symmetrical patches on the face and occasionally on the backs of the forearms. It is nine times more common in women than in men, and it is more prevalent in darker-skinned individuals.
Although the cause of melasma is unknown, all cases occur on sun-exposed skin. And while it is usually associated with pregnancy, 10% of melasma cases occur in nonpregnant women or in men. Melasma is also associated with the use of certain medications (e.g., oral contraceptives or Dilantin).
Melasma is painless, and it has not been correlated with serious underlying disease. However, affected individuals often find the hyperpigmentation unsightly and embarrassing.
Melasma typically presents in one of three patterns, and three different types have been described, based on the depth of skin involvement.
Patterns of Melasma (Mask of Pregnancy)
- Centrofacial (63% of cases): Involves the nose, forehead and cheeks
- Malar (21% of cases): Involves the cheeks and temples
- Mandibular (16% of cases): Involves the jawline
Types of Melasma (Mask of Pregnancy)
- Epidermal: Tends to be light brown and enhances with a Wood’s lamp. More responsive than other types to topical therapies
- Dermal: Typically grayish in color; does not enhance with Wood’s lamp. Less responsive to topical therapies
- Mixed: Tends to be dark brown with variable enhancement under Wood’s lamp examination. Variably responsive to topical therapies
Treatment of Melasma (Mask of Pregnancy)
- Melasma that is secondary to pregnancy or the use of oral contraceptives tends to fade several months after delivery or discontinuation of contraceptives. Patience and watchful waiting may bring a satisfactory result in these cases.
- Cosmetics can be used to blend and camouflage affected areas.
- For epidermal and some mixed-type melasma, topical treatment with hydroquinone, glycolic acid peels, azelaic acid, and retinoids are somewhat effective. Hydroquinone in combination with retinoids, glycolic acid, or topical steroids is probably more effective than any single agent.
- One study involving triple-combination treatment of epidermal melasma with Tri-Luma cream (fluocinonide, hydroquinone, and tretinoin) showed significantly greater improvement than treatment with any two of these ingredients in combination. The study was sponsored by the company which makes Tri-Luma cream.
- Laser therapy or intense pulsed light therapy combined with hydroquinone and sunscreen may be effective in dermal or refractory mixed-type melasma. Laser therapy is not recommended for epidermal melasma. (Nouri K, et al. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surg. 1999;25(6):494-97 and Wang C, et al. Intense pulsed light for the treatment of refractory melasma in Asian persons. Dermatol Surg. 2004;30(9):1196-1200)
- Treatment for melasma typically must be continued indefinitely for optimal results.
Prevention of Melasma (Mask of Pregnancy)
The most effective means of preventing melasma is to decrease exposure of susceptible skin to ultraviolet light (i.e., sunlight). Opaque sunblocks (titanium dioxide or zinc oxide) are most effective, as they block the most sunlight.
Transparent or vanishing sunscreens containing titanium dioxide or zinc oxide (Neutrogena Sensitive Skin Sunblock 30+, Solbar Zinc Sunscreen SPF 38, etc.) are also available and somewhat effective. (Plensdorf S and Martinez J. Common pigmentation disorders. Am Fam Phys 2009;79(2):109-116)
Melasma, or the mask of pregnancy, is a cosmetically distressing condition that is often responsive to treatment. Cases secondary to pregnancy or oral contraceptive use are often self-resolving, while treatment for other cases may be prolonged.
