Skin Deep

A Closer Look at Melasma

Skin discoloration, or hyperpigmentation, is usually a sign of sun damage that begins to worsen as years of unprotected sun exposure rise to the surface of the skin. While typical age spots become visible around the late ‘30s and early ‘40s, a skin condition called melasma usually makes its presence known much earlier.

Melasma appears as dark patches, most commonly on the upper lip, cheeks and forehead. Most prevalent in women of Latin or Asian heritage, this discoloration can also appear during pregnancy; then it’s called chloasma. We know there’s a link between melasma and hormones, which is why women who take oral contraceptives are more prone to the condition.

Unlike sun-related hyperpigmentation that occurs later in life, melasma peaks between the ages of 20 and 40, when estrogen levels are at their highest. Once a woman reaches menopause, melasma symptoms begin to subside.

Although there are prescription medications that can curb the discoloration associated with melasma, the key to minimizing dark patches is prevention. It’s important to wear sunscreen every day (365 days a year, rain or shine) and avoid the sun. You may also want to rethink your birth control, and even avoid facial waxing and steaming during facials, as heat can make melasma worse. Although melasma tends to subside with menopause, hormone replacement therapy can lead to further skin darkening.

Recent research has also established a link between stress and melasma. Stress can activate the propriomelanocortrin gene that prompts the skin to produce more pigment. Our bodies also interpret lack of sleep as stress, so this too can make melasma symptoms worse. This gene has an effect on all pigment production, but if you’re concerned about melasma, then it’s important to look at all of these factors as causes for the discoloration. Your dermatologist can recommend the best skincare, prescriptions and treatments to help get your melasma under control, but this is only one part of the picture. For optimal skin clarity and radiance, don’t underestimate the toll your lifestyle takes.

Dr. Leslie Baumann is a board-certified dermatologist, New York Times best-selling author and CEO of Baumann Cosmetic & Research Institute in Miami.