Blame it on the hormones? Well, maybe. “In some cases,” notes Jennifer Wong, a certified registered physician’s assistant specializing in dermatology with Advanced Dermatology PC, “the dark skin patches called ‘melasma’ occur at the same time a woman experiences hormonal changes. But we’re still learning about the nature of the connection.”

In this country, as many as six million people a year – ninety percent of them women – experience darkened patches of facial skin, usually brown or gray, the result of overproduction of the skin pigment melanin.

“In particular,” says Wong, “women with darker skin tones are more susceptible because their skin has more active melanocytes – the skin cells that produce melanin. Genetics also seems to play a role: having a family member with melasma increases the possibility of developing it yourself.”

And, of course, there is the role of the sun. “The sun triggers our melanocytes,” observes Wong. “With melasma, little exposure may cause the discoloration. Unlike ‘age spots,’ melasma is not due to cumulative sun, and often occurs in young women. In some cases, even the light of our computer or cell screens can contribute to melasma.”

Melasma usually appears on the center forehead, over the brows, on the bridge of the nose, on the chin, and on the upper lip. “All places that get sun exposure,” observes Wong. “In some cases, melasma occurs on other frequently exposed areas like our forearms.”

When melasma co-occurs alongside hormonal changes due to pregnancy, birth control pills, or hormone replacement, it can spontaneously resolve when hormones return to previous levels, for example after the pregnancy or if medications are discontinued. “But in other cases,” notes Wong, “melasma persists. While it is medically harmless, its appearance on one’s face can be distressing. Fortunately, we have a number of options to lighten melasma.

With that in mind, Wong makes the following suggestions:

1. First, get a clear diagnosis: “It’s important,” says Wong, “to rule out any skin condition that requires medical treatment. A skin specialist can do an examination and, if needed, a biopsy. Once you have a clear diagnosis, you can work with your provider on a treatment plan.”

2. Skin lighteners can help: “In particular,” notes Wong, “topical use of hydroquinone – or HQ – can be effective. HQ comes in varying strengths, including less concentrated over-the-counter formulations, as well as combined with other topicals, such as the retinoid tretinoin and a corticosteroid, in a so-called ‘triple cream.’ Other topical lighteners include azelaic acid and kojic acid. Your skin-care specialist can help guide your choices.”

3. Choose OTC products with care: “An alarming number of OTC skin lighteners contain mercury,” advises Wong, “a neurological toxin that can also injure the children and partners that people come into close contact with. Your skin specialist’s guidance can be especially helpful because some products do not clearly identify ingredients, using different terms for mercury, including calomel, cinnabaris, hydrargyri oxydum rubrum, or quicksilver. In addition to hidden mercury, we have also seen products with unlisted steroids, which can cause skin damage.”

4. Outpatient procedures can help, too: “Lasers,” explains Wong, “can penetrate down to melanocytes to block melanin production, while chemical peels can remove hyperpigmented surface skin. Again, your skin specialist can explain outcomes, time involved, and side effects to help customize a treatment plan that is the best fit.”

5. Throw shade on the chance of reoccurrence: “The sun activates our skin’s production of melanin,” notes Wong. “Melasma can be triggered by minimal exposure, regardless of season or weather, so patients will want to be vigilant about protecting themselves from the sun – every day, all year. A broad-spectrum SPF 30 mineral sunscreen with zinc oxide or titanium dioxide can help physically block rays. Patients will also benefit from protective clothing, including a wide-brimmed hat and sunglasses.”

“Fortunately,” Wong concludes, “patients can take action now to reduce the appearance of melasma, as research continues to connect the dots between hormones and other factors.”

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