What Is Chloasma?

Melasma is a skin condition caused by heightened activity in melanocytes, the pigment cells in our skin, leading to increased melanin deposits in both the outer (epidermis) and inner (dermis) layers. This results in dark, uneven pigmentation patches, particularly on sun-exposed areas like the face. While often seen in pregnant women, especially on the upper cheeks, melasma can also appear in non-pregnant women, particularly those of reproductive age, and might recur.

Its exact origins remain unclear, though potential triggers include genetic factors, sun overexposure, hormonal fluctuations, certain medications, and, occasionally, unknown causes. Some skincare products and cosmetics, especially those that heighten sun sensitivity or are used for epilepsy, may raise the risk. Notably, oral contraceptives could double the chances of developing melasma, and it’s crucial to understand that men can also be affected by this condition.

Chloasma presents as one of the following:

• Dark and irregular patches on the skin, especially of the face which vary from light brown to dark brown. The patches are often associated with irregular pigmentation, although the lesions are usually symmetrical and can also affect the forehead as well as the common lesions on cheeks and the lateral area of the cheeks (malar area is the commonest site).
• Symmetrical distribution on cheeks, forehead, nose and even the upper lip
• Distinct appearance often resembling a mask
• Typically no physical discomfort but psychological impact is possible
• Can be associated with dry skin
• Can be associated with inflammation of the skin which results in red areas within the dark pigmentation

Chloasma is diagnosed by its typical appearance. Possible methods of diagnosis include:

• Typical appearance, especially when observed by a skin specialist (dermatologist or obstetrician)
• A Wood’s lamp examination of pigmented areas
• Occasionally when the diagnosis is uncertain, a small skin biopsy can confirm the diagnosis

The treatment for chloasma is not straightforward. This is because it is commonly a relapsing condition and treatment may be less than effective but should improve the level of pigmentation. Treatment options include:

• Consider any trigger factors such as the pill, overexposure to sunlight or other drugs known to be associated with pigmentation
• Protection against sunlight, obvious sun avoidance due to protective clothing and effective sunscreen. It is best to use a sun protection factor (SPF) of 50 or higher
• Topical skin lightening agents to reduce pigmentation
• Chemical peels that exfoliate the skin and promote renewal
• Laser therapy – particularly considered for stubborn cases

Chloasma is often a chronic condition with the risk of relapse and so preventative therapy such as the use of sunscreen is particularly important.

Especially in pregnant women and women on the oral contraceptive pill, once the hormone stimulation has resolved then the chloasma often slowly improves over a period of months or sometimes years. The maximum improvement is usually noticed in the first few months. The ultimate outcome varies enormously between individuals and there may be a complete resolution or there may be some residual pigmentation.

The actual degree of resolution and the chance of recurrence certainly depends on genetic predisposition, your original skin type, your response to hormones, especially those produced in pregnancy and those associated with the use of the oral contraceptive pill.

Avoidance, especially if you have already had melasma or have a genetic or hormonal predisposition includes avoiding overexposure to sunlight and the sensible use of sun protection factors.

If chloasma is a cosmetic or distressing symptom for you, you should seek appropriate medical care to see what can be done to minimise the level of pigmentation but also what can be done to avoid recurrences.