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melasma: the emotional impact of skin disease
4 minute read
patients with melasma often describe feeling shame, frustration, low self-esteem, a lack of motivation to go out.
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melasma is commonly known as a chronic hyperpigmentation skin disease that affects up to 50 per cent of the population, of all skin colours, worldwide. there is also a genetic predisposition — up to half of patients with melasma also have a family member with the condition. the prevalence of melasma is the highest among females, and darker skin types including indian, latino, asian, hispanic, middle eastern and african descents.
and while this skin condition is benign, it can have a profound negative affect on quality of life and self-esteem because of its perceived effect on attractiveness.
psychosocial and emotional distress
patients with melasma often describe feeling shame, frustration, low self-esteem, a lack of motivation to go out, and experience a higher degree of expenditures on treatments and cosmetics to combat the appearance of their skin. interestingly, quality of life scores do not necessarily correlate to the severity of pigmentation changes, suggesting that any degree of pigment can be impactful to the individual.
what causes melasma?
repeated ultraviolet radiation (uv) exposure is a cause of melasma. basically, sunlight stimulates the skin to produce more melanin in some areas than others — thus, the uneven patches of colour that defines this condition.
of course, we already know that sun damages the skin, flattening the layers of skin and accelerating collagen and elastin breakdown. these biological processes and physical changes beneath the skin allow pigment to move deeper and can decrease the effectiveness of treatments.
melasma also seems to be related to female hormones, and tends to occur most commonly during pregnancy or in women who use oral contraceptives. but there are other important contributing factors, including other hormones (thyroid, adrenal, pituitary, msh), as well as topical cosmetic use, medications that increase sun sensitivity, and heat exposure — all of which affect the production of skin pigment.
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what does melasma look like?
melasma is characterized by a brownish patchy pigment which develops symmetrically, but with irregular contours, most often on the forehead, cheekbones, chin and jawline. other areas include the upper lip, neck, chest, arms, shoulders. it doesn’t spread and is not contagious.
how can i tell if i have melasma?
sun damage can cause hyperpigmentation of the skin, but this is different from melasma. sun damage tends to appear in the form of freckles or dark patches, but doesn’t usually have a pattern. it’s important to note that all types of sun-damaged skin age more harshly than other skin by comparison.
diagnosing melasma
melasma is most often diagnosed by using a wood’s lamp or a dermatoscope to examine the characteristics of the pigment differences in the skin, as well as taking account details like when the changes began, how much sun exposure the patient has had and the factors that potentially triggered the pigment changes, such as new medications, or chemical exposure. according to the canadian skin patient alliance, your doctor may also investigate other potential reasons for the patches, such as menopause, certain types of ovarian tumours and disorders such as addison’s disease.
how is melasma treated?
melasma cannot be cured, and sometimes, it resolves on its own, for example when pregnancy ends or when a woman stops taking oral contraceptives. in cases where the pigment runs deep in the skin, correction treatments typically focus on lightening, lifting and suppressing the pigment with medical-grade skin care or prescription regimens.
topical ingredients work by blocking the development of pigment, as well as removing the patchy skin through peeling and exfoliation. but often, other treatment options are needed to achieve the best results such as chemical skin peels, platelet-rich plasma (prp), microneedling and laser treatments. it is important to ensure that some of these treatments, particularly those involving lasers, will need to be performed using less energy and taking more time between treatments to prevent the patches from getting worse. it’s always best to choose a medical practitioner with expertise in this condition in order to have the best chance of success.
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how to prevent melasma
prevention and protection are key to managing melasma — avoid exposure to the sun, and wear sunscreen. inorganic or physical sunscreens are best for melasma because they reflect and scatter light. containing zinc oxide, iron oxide, and titanium dioxide, these sunscreens protect against all uv and visible light. topical vitamin c should also be considered since it can boost the efficacy of sunscreens. other preventive strategies include choosing spf clothing and hats.
general skin care is also important to protecting against melasma, helping to build a healthy barrier to damage and reducing the inflammation linked to skin diseases. yearly skin exams to rule out skin cancer are essential for anyone, but especially those whose skin shows signs of sun damage or who have had moderate lifetime sun exposure. sun-induced aging will worsen age-related alterations of the skin such as skin fragility, blood flow, wrinkles, elasticity, hydration, capacity to recover, and increase the risk of skin diseases like melasma, but also skin cancer and rosacea.
frances krawiec is a nurse practitioner at preventous cosmetic medicine.
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