Well, for some people, the summer can make their skin condition worse despite their best efforts to limit sun exposure. Melasma is the most common skin disorder in this category.
Melasma causes hyperpigmentation, or darkening of the skin, but it is distinctly different than normal tanning. It results in irregular patches of darker skin usually much darker than normal tanning and even when tanning fades, these areas remain darker than the paler normal skin.
Melasma occurs only in sun-exposed areas, and appears much more commonly on women (who are 9 times more likely to get it than men). It develops most commonly in areas that include the face, neck and arms.
Despite extensive research, no one really knows what causes melasma, although there does appear to be a genetic basis. There is also an evident hormonal basis, as melasma usually develops in times of hormone fluctuations such as puberty, pregnancy, or use of and changes in birth control medications.
Skin biopsies have shown that melasma sufferers do not have more pigment cells (melanocytes) in the areas affected. However, the melanocytes in these individuals are larger, produce more melanin, and, as a result, more intensely stain surrounding tissue.
There is no single test to diagnose melasma. It is what we call in medicine a clinical diagnosis. In other words, a doctor knows it when he sees it.
From my own observations over the years, I have seen that everyone is different in their presentation. Some have darkening of only one location such as the upper lip or sides of their neck, while others will have multiple areas involved in various combinations.
I have also observed that treatment success depends on the darkness of the color and how long the discoloration has been present. Those melasma patches that are lighter in discoloration and/or have been present the shortest amounts of time are usually treated most successfully.
Not surprisingly, melasma has been shown to have a significant negative affect on women psychologically and on their quality of life. Depending on the location of the discoloration, they are frequently asked if they have dirt on their face. Upper lip darkening is particularly alarming, as it looks like hair growth to the casual observer.
Obviously, I always emphasize prevention for things we can control. That means sun avoidance and sun protection. Hats, UV-resistant clothing and sunblock are the hallmarks of this strategy.
Regular use of sunscreens is necessary to prevent the melasma in those with that tendency as well as enhance the effectiveness of treatment. Due to the hormonal association, I usually recommend a discussion of women with their gynecologist is the onset of melasma occurred around the time of starting or changing birth control medications.
I mentioned treatment, but that is an extensive discussion as it involves multiple possible approaches. I will address melasma treatment in the next blog post. In addition to the therapies I have recommended over the past few years, we have added a new weapon in the battle against melasma, which I will discuss in detail at that time.