This week I had a client that had been forced to purchase extremely expensive treatment for Melasma/Chloasma or Butterfly Mask of Pregnancy, which is a common skin discoloration that occurs on the face in the form of brown patches. This mainly affects women and commonly occurs in pregnant females, having darker or olive skin, (Asian, Hispanic, Latin, Greek, Middle Eastern, Indian, African) but can even though it’s rare it can occur with men. Melasma occurring in the pregnancy is known as chloasma, also known as “the mask of pregnancy or the butterfly mask.” In pregnancy, there is increase in hormones, such as progesterone, estrogen, and MSH or melanocytes-stimulating hormone leading to chloasma. It always worries me when patients are not informed fully of their options especially when a condition can naturally be resolved by treating the cause and not the symptoms.
Causes of Melasma/Chloasma or Butterfly Mask of Pregnancy.
Though the exact cause of melasma/chloasma condition is not known, according to research, it is triggered by various factors, such as birth control pills, pregnancy, hormone replacement therapy(HRT), having a family history, ethnicity, medications for seizure and other such medications which make the skin vulnerable to pigmentation upon sun exposure or UV rays (ultraviolet) exposure. In addition, products or treatments can cause an increase in melanin production and accelerate the symptoms due to these products irritating the skin causing a inflammatory reaction.
Where Melasma Occurs.
It is easy to diagnose this type of skin condition due to its distinct characteristic and areas affected on the face. It can be seen clearly during examining the skin and confirmed under black light – Wood’s lamp. Melasma is the hyperpigmentation seen mainly on the face, there is 3 main areas that area which are affected.
- Center of the face or centro-facial.
- On the cheek bones or malar.
- On the jawbone or mandibular.
- Other regions which are not commonly involved are forearms and sides of the neck.
Most of the times there is a mixture of normal pigmentation and melasma/chloasma on the patients face which means that the discoloration/pigmentation is in the epidermis as well as the dermis level of the skin.
Treatment for Melasma/Chloasma or Butterfly Mask of Pregnancy.
It must be said that if you remove the hormonal influence the melasma will reduce or fade away all on its own but this can take up to 2 years and you must be diligent with a zinc/titanium sunscreen and avoiding the sun. But if you wish to speed up the time and the pigmentation you can employ the following once the hormonal influence is removed
- Prescription-strength creams which have 4% hydroquinone in them such as Tri-Luma, Obagi Clear etc, this higher concentration can cause skin irritation and must be used under the supervision of a medical practitioner and a high quality sunscreen must be used everyday.
- In salon treatment – chemical peels, micro dermabration and my new favourate Fractional RF.
- Home Treatment – Cream/Serums with retinoic acid, AHA, kojic acid is also prescribed. Weekly Exfoliation with a physical/chemical exfoliation.
- Using sun protection regularly boosts the effectiveness of melasma treatment .Sunscreen with a minimum SPF of 20 to stop both the UV-A and UV-B rays. I am always believe and recommend a zinc/titanium based sunscreen as this type of sunscreen reflect the sun and not absorb the sun.
The expensive cream did fix the Melasma of my patient but it did leave her with hypo-pigmentation spots (no color in the skin) she is now getting cosmetic tattooing to add color back into the skin. The horrible fact is that she just had a baby and the Melasma/Chloasma would have just faded away naturally with simple diligence of sunscreen and her hormones returning to normal.