At what stage in your life did melasma occur, and what was the cause (if known)?
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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
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.