Brown patches on your skin? … Here’s what you need to know about them

Melasma is a skin condition consisting of brown patches caused by an increase in the pigment melanin in the skin. The increased melanin can be in the superficial (outer) layer of the skin called the epidermis and/or deeper in the skin in the layer called the dermis.

It usually occurs on both sides, in a symmetrical pattern of sun-exposed areas, especially the cheeks, upper lip, chin and forehead. It may also occur on areas of the arms and chest.

It is most common in Hispanics, Asians and people of African descent and is much more common in women.

Melasma is among the most common skin conditions seen by dermatologists in skin of colour. It can cause a lot of emotional distress to affected individuals.

RISK FACTORS

The risk factors for melasma include:

- Genetics

- Sunlight

- Pregnancy

- Oral contraceptive pills

- Hormonal therapy

- Drugs which cause sun-induced rashes

- Thyroid disorders

- Some cosmetics

If the pigment is closer to the surface of the skin, the patches are usually more well defined, darker and more prominent on UV lamp (Woods lamp) examination. If it is deeper the patches are usually less well defined, may appear lighter and unchanged on UV lamp (Woods lamp) examination. In most cases of melasma, there is a mixture of superficial and deep melanin. The more superficial the melasma is, the easier it is to treat.

Treatment involves reducing risk factors. Sunscreens and sun protection are important. A broad spectrum, water resistant sunscreen with SPF of at least 30 is recommended for use in everyone.

It should be applied 15-30 minutes before sun exposure and reapplied every two hours when outdoors, and after swimming based on the duration of water-resistance. Sunscreens with zinc oxide or titanium dioxide are safest for use in sensitive skin.

Ultraviolet light and visible light can both worsen melasma. Sunscreens with iron oxide and/or tinted sunscreens can also help protect against visible light.

Oral Polypodium leucomotos supplement can be used in addition to sunscreen to increase sun-protection.

Some topical treatments of the brown patches of melasma include:

- Hydroquinone (more effective in combination with a retinoid and mild to moderate corticosteroid)

- Retinoids

- Hydroxy acids

- Azelaic acid

- Kojic acid

- Ellagic acid

- Niacinamide

- Arbutin

- Mequinol

- Tranexemic acid

- Vitamin C

- Soy

- Emblica

- Resorcinol

- Licorice extracts

- Pycnogenol.

There are many more substances that have also helped to treat melasma. Additional treatment approaches include:

- Microdermabrasion

- Chemical peels

- Micro-needling

- Lasers (for example, Nd:YAG (650-microsecond laser), Q-switched Nd:YAG, picosecond lasers)

- Fractional radiofrequency

- Cover up cosmetics

- Psychological support

The 650-microsecond laser (Aerolase Lightpod neo) is a novel, safe and effective treatment for deeper melasma in skin of colour and can be combined with other treatments.

Melasma tends to be a chronic (long term) skin condition. It can be treated and controlled with great results. If bothered by melasma, affected individuals should keep up with efforts to prevent and treat it.

Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas. Email: yourhealth@gleanerjm.com