Uneven pigmentation is one of the most common complaints that skincare professionals hear in the treatment room, along with aging and acne concerns. However, changes in skin pigmentation can arise due to many different factors. Perhaps one of the most challenging pigment conditions to treat is melasma, a common hyperpigmentation disorder that affects millions, the majority of whom are women.
In some ways, melasma, a condition that causes gray or brown patches on the face, is a mystery. Many more women than men have this condition. On the skin, it looks like brown or dark patches that typically appear on the forehead, cheeks, and chin.
Although exposure to the sun and hormones are closely associated with triggering or worsening melasma, much remains to be understood about the origin and development of the disorder.
Vital pigment: melanin
To understand pigmentation disorders, it is important to understand the basics of human skin color and its protective function. Despite the great variety in human skin color, all the variations we see are due to the presence of a pigment called melanin.
Starting with the Greek word melas, which means black, melanin is made up of two forms: brownish-black eumelanin and reddish-yellow pheomelanin.
Studies have shown that melanin production leads to skin color that ultimately protects the individual from solar radiation and vitamin D deficiency.
Therefore, the unique complexions of our ancestors evolved to be dark enough to protect DNA from UV damage and light enough to allow UVB to penetrate for vitamin D synthesis, depending on the amount of UVR available.
That is why melanin is vital to our health, too much melanin and we run the risk of vitamin D deficiency and disease; too little melanin and we run the risk of skin cancer and death.
Hormones, UVR, and inflammation stimulate melasma
But the color of the skin is beyond the skin. The same embryonic tissue that gives rise to neurons in the brain also gives rise to melanin found in the skin, eyes, and hair. The production of melanin in the skin, or the melanogenesis process, is under the influence of several internal and external factors.
In addition to UVRs, hormones and inflammatory signals can stimulate the melanocyte to increase melanin production and / or increase melanin transfer to keratinocytes.
In both cases, the result is a darkening of the skin. Because many key players affect skin pigmentation, the observed changes can be transient (during pregnancy), permanent (intrinsic aging), environmental (with UV exposure), and external (certain drugs or medications).
Although melasma was thought to be a pregnancy and contraceptive related disorder in the past, new research shows that, for many people, including men, it is a chronic disorder that lasts for decades.
Melasma: a new understanding
Historically, this disease was considered a hyperpigmentation disorder in women experiencing hormonal changes. Today, we know that it is more complicated than that. While we have yet to find the exact cause, current theories suggest that hormones, UV exposure, and genetics are the main influences of the disorder.
Melasma and genetics
Let's start with genetics. Melasma is more common in darker skin types, particularly Fitzpatrick skin types III and IV, and is estimated to affect 8.8 percent of Hispanic women (US data) and 40 percent of Hispanic women. Southeast Asian. The relatively new finding comes from studies on different ethnic populations.
For example, 55 percent of pregnant Iranian women reported having a family member with this condition, while 70 percent of Puerto Rican women reported the same family link. Interestingly, melasma runs in families regardless of whether a man or a woman inherits the disease.
One study showed that 70 percent of Latino men with this type of pigmentation also had a family member with the same. Clearly, there is a genetic component that is not unique to women.
Melasma and ultraviolet rays
In many people who get melasma without the hormonal component, a combination of factors including family history, age, and UV exposure triggers the disease. Melasma usually occurs in areas exposed to the sun, where UV radiation has activated or worsened pigmentation.
Under the microscope, skin with this condition can even resemble photodamaged skin, with hallmarks like solar elastosis. Inflammation is likely to play an important role and
n skin exposed to the sun, as UV-stimulated inflammatory signals, including cytokines and alpha-melanocyte peptide-stimulating hormone (α-MSH), can also trigger melanogenesis.
So with exposure to UV rays, there is a direct and indirect way to stimulate the melanocyte to produce more pigment. As new research emerges, we may find that infrared or even visible light can be a trigger for those susceptible to melasma.
And because sun exposure is a critical factor in the development of melasma for both men and women, educating yourself on proper sun protection as part of a regular skin care regimen is the most important advice.
Hormonal triggers of melasma
Pregnancy is a time when you can expect the unexpected. In addition to the variety of skin changes that a woman can experience during pregnancy, some degree of hyperpigmentation affects almost all women. However, in some women, the level of hyperpigmentation increases markedly.
These spots occur in 10-15 percent of pregnant women and in 10-25 percent of women taking oral contraceptives. For decades, melasma was known as " the mask of pregnancy, " with the assumption that it must be caused by increases in female hormones due to pregnancy or the pill. The reality is that we still don't clearly understand the hormonal link to melasma.
Melasma is sensitive to estrogens
Melasma skin is more sensitive to estrogens than skin without it. However, other hormones involved in a woman's menstrual cycle and pregnancy, including progesterone and a-MSH, can also stimulate pigmentation. And just as melasma skin is more sensitive to estrogens, it has also been shown to be more sensitive to progesterone than normal skin.
The notion that oral contraceptives can cause skin changes is not new. this problem was shown to develop in women as a direct result of taking oral contraceptives.
If you browse online skincare forums, you will see many women recommending trying a progestin-only method of birth control to relieve melasma. However, there is no evidence that this helps.
Still, the only way to relieve contraceptive-induced melasma is to stop the medication. While pregnancy-induced melasma will usually fade within a year after delivery, contraceptive-induced melasma will persist as long as the drug is used. In some cases, this can take years to fully resolve.
Thyroid hormone and melasma
In addition to sex hormones, thyroid hormone may also play a role in the development of melasma, as people with melasma are four times more likely to have a thyroid abnormality than those with normal skin pigmentation.
In summary, although several hormones are involved in activating melasma, your elevated levels are not always found in the skin of melasma, which means that they are not the maximum factor in developing the disease.
A vascular disorder?
Whether it is a man or a woman, melasma appears on areas of the face exposed to the sun as flat, distinct areas of discoloration. These dark patches usually appear on the forehead, cheeks, and chin in a symmetrical fashion.1 Interestingly, vascular diseases such as rosacea also appear in these central facial regions.
Scientists looking at the role blood vessels play in the development of melasma have found that melasma skin has more numerous and larger blood vessels than skin without melasma, in both men and women. Not surprisingly, vascular disease is also a common affliction among women.
Hopefully new research will emerge looking at the role hormones play in vascular and pigmentary changes to better understand this frustrating condition.
Patience, persistence, and caution
Because melasma is a persistent condition, you are sure to make regular visits to your skincare center as well as daily care to resolve, and it can even get worse at times.
Remember that hormones continually trigger the condition, so treatment for hormone-induced melasma should only begin after breastfeeding has been completed or contraceptive medication has been changed. And lastly, caution is crucial because you could inadvertently worsen the pigmentation of melasma by triggering inflammation in the skin.
Chemical peels can improve the appearance of epidermal melasma skin, but extreme care must be taken in choosing the correct peel formulation and treatment protocol to avoid hyperpigmentation.
People who tend to get melasma are also more sensitive to ultraviolet and harsh chemicals, which can trigger hyperpigmentation, so using the correct daily care products is also crucial for the treatment result.
Although you will do regular treatments, remember that your skin may be different with each visit. Be especially careful when under stress, as the stress hormone cortisol can sensitize the skin and trigger inflammation.
Since melasma pigmentation can worsen during times of stress, you may want to address the inflammation before pigmentation in this case.
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