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Causes of melasma

Melasma, also known as chloasma, is a tan or dark facial skin discoloration. It is one of the most challenging skin conditions to treat, and can reappear. Melasma appears as dark irregular patches which are commonly found on the upper cheek, nose, lips, upper lip, and forearm. These patches usually develop gradually over time, and do not cause concern for any other symptoms beyond cosmetic discoloration. With melasma, there are numerous factors to consider as well as underlying conditions that trigger hormonal responses.

Melasma and Ethnicity

Melasma is most prevalent in men and women of darker skin colors, or those of Fitzpatrick skin phototypes III-VI. With melasma, ethnicity should also be considered. The occurrence of melasma is commonly found with people of Native American, German, Russian, or Jewish decent. When treating melasma, both skin color and genetic predisposition should be considered. With lighter skin types, predisposed factors such as ethnicity should be an important consideration as well, which can contribute to an increase of melanocyte activity and melasma. With an increase of melanocyte activity, individuals with darker skin types such as African, Hispanic, Indian, Middle Eastern, Mediterranean and Asian, are at a greater risk to melasma and hyperpigmented disorders. The individual who is most susceptible to develop melasma, are women that have a light brown skin type, and have had intense sun exposure.

Hormones, Medications and Melasma

Melasma is a condition that is commonly found in pregnant women, women taking oral contraceptives, or women on hormone replacement therapy (HRT). In pregnant women, melasma tends to fade post-partum, but can return with subsequent pregnancies. The discoloration will usually disappear over a period of several months after giving birth. On the other hand, melasma caused by oral contraceptive use typically does not fade after discontinuing use of the drug.

Endocrine Disorders; Increased Risk Factors

There are certain medical conditions that can bring the onset of melasma, and can increase in patients with thyroid disease. With endocrine disorders such as Addison’s disease, a minor injury can stimulate the onset of melasma.

Melanocyte Stimulating Hormone and Stress

It is thought that the overproduction of the melanocyte stimulating hormone (MSH) brought on by stress, can cause outbreaks of melasma. Other rare causes of melasma include allergic reaction to medications and cosmetics. Predisposed factors such as ethnicity should be considered with medications and cosmetics, as well as stress levels which can cause an imbalance in the endocrine system.

Inflammatory Responses Stimulates Melanocyte Activating Hormones

Hormone-like substances commonly called inflammatory mediators activate a wide variety of responses in the skin, including an increased release of histamine, and activation of melanocytes. During an inflammatory response or UV exposure, the skin may produce as many as eight to ten different types of melanocyte activating hormones, which bind to specific receptors on the surface of melanocytes, triggering the activation of the cell from its resting state to a melanin-producing, active state.

Exasperating Melasma; The Affects of UV Radiation

Ultra violet radiation contributes to the development and the exasperation of melasma. UV radiation can cause both, an increase in melanin production and transfer, as well as an increase in the number of melanocytes. Individuals with lighter skin types (Fitzpatrick Phototype I-II) and living in an area of high sun exposure are at a high risk of developing melasma, as well as predisposed ethnicities. Years of UV exposure induces a constant production of inflammatory hormones, and ultimately results in a permanent activation of melanocytes.

Linda Gulla is a physician endorsed Master Esthetician who offers CME and CE to licensed professionals and has authored the first in a series in Medical Aesthetics. Her resource material and correspondence certification can be found at

She can be reached at:

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