Melasma - Causes

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What causes melasma?

The exact cause of melasma remains unknown. Experts believe that the dark patches in melasma could be triggered by several factors, including pregnancy, birth control pills, hormone replacement therapy (HRT and progesterone), family history of melasma, race, antiseizure medications, and other medications that make the skin more prone to pigmentation after exposure to ultraviolet (UV) light. Uncontrolled sunlight exposure is considered the leading cause of melasma, especially in individuals with a genetic predisposition to this condition. Clinical studies have shown that individuals typically develop melasma in the summer months, when the sun is most intense. In the winter, the hyperpigmentation in melasma tends to be less visible or lighter. Heat, such as that experienced in a bakery or factory, is also thought to be a cause.

When melasma occurs during pregnancy, it is also called chloasma, or "the mask of pregnancy." Pregnant women experience increased estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels during the second and third trimesters of pregnancy. Melanocytes are the cells in the skin that deposit pigment. However, it is thought that pregnancy-related melasma is caused by the presence of increased levels of progesterone and not due to estrogen and MSH. Studies have shown that postmenopausal women who receive progesterone hormone replacement therapy are more likely to develop melasma. Postmenopausal women receiving estrogen alone seem less likely to develop melasma.

In addition, products or treatments that irritate the skin may cause an increase in melanin production and accelerate melasma symptoms.

People with a genetic predisposition or known family history of melasma are at an increased risk of developing melasma. Important prevention methods for these individuals include sun avoidance and application of extra sunblock to avoid stimulating pigment production. These individuals may also consider discussing their concerns with their doctor and avoiding birth control pills and hormone replacement therapy (HRT) if possible.

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See what others are saying

Comment from: Lisa Torres, 45-54 Female (Patient) Published: May 21

I have melasma. Mine started when I started peri-menopause. So mine is due to hormonal changes. My dermatologist prescribed a cream for me called Tri-Luma. About 5 days later, there was a noticeable difference and the brown spots looked so much lighter. Of course I use a really good sunscreen called La Roche-Posay. Most insurances don"t cover the cost of the Tri-Luma because it is for cosmetic purposes. The cost with tax is around $120.00 but well worth it. You only use very little.

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Comment from: Chanel, 19-24 Female (Patient) Published: July 08

I'm 23 years old and I got melasma when I was pregnant at 18. First I thought it was going to go away after the pregnancy, so I ignored it. Seeing it now, it actually looks worse than before because it has spread up to my back. Other than stretch marks from pregnancy, this is my main concern on my body. All the creams are too expensive for me to get. So I'm looking for alternative ways to get rid of it, i.e., eating fruits rich in vitamin E and taking dietary supplements. I have yet to see if eating fruits rich in Vitamin E will actually help get rid of these dark/light spots on my back and glutes.

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