Melasma: 

Melasma (also known as chloasma or the mask of pregnancy when present in pregnant women) is a dark skin discoloration. 

Melasma is considered to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. 

Although it can affect anyone, it is prevalent in women, especially pregnant women and those taking oral or patch contraceptives or hormone replacement therapy medications.

Melasma occurs in sun-exposed areas as acquired hyper melanosis, presenting as symmetrically distributed hyperpigmented macules which can be confluent or punctate. It is worse in the regions that receive excessive sun exposure, including the cheeks, the upper lip, the chin, and the forehead.

Etiology

Etiologic factors include genetic influences, ultraviolet (UV) radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications.

Melasma stimulates melanocytes by the female sex hormones estrogen and progesterone, producing more melanin pigments when the skin is exposed to the sun.

Genetic 

Genetic predisposition may be a significant factor in the development of Melasma.

• Melasma is more common in females than in males.
• Persons with light-brown skin types from regions of the world with high sun exposure are more prone to the development of Melasma.
• Approximately 50% report a positive family history of the condition. Identical twins have been reported to develop Melasma.

Sun exposure: 

UV radiation can cause lipids peroxidation in cellular membranes, resulting in free radicals which could stimulate melanocytes to produce excess melanin.

Hormones

There’s an increased frequency of chloasma occurrence in pregnancy and among women taking birth control pills or undergoing estrogen replacement therapy. It can also occur in men undergoing estrogen treatment for prostate cancer because it is caused by changes in hormonal activity.

Thyroid Disease

There is a four-fold increase in thyroid disease in melasma patients.

Epidemiology

Persons of any race can be affected. Melasma is more common in darker skin types than in lighter skin types and is particularly more common in light brown skin types. Women are affected nine times more than men. Melasma is rare before puberty and more common in reproductive years. Melasma is present in 15% to 50% of pregnant patients. The prevalence varies between 1.5% and 33%, depending on the population.

Pathophysiology

The most critical factor is exposure to sunlight. UV radiation induces the production of alpha-melanocyte-stimulating hormone and corticotropin as well as interleukin 1 and endothelin 1, which contributes to increased melanin production by intraepidermal melanocytes. Prolonged UV exposure-induced dermal inflammation and fibroblast activation upregulate stem cell factors in the melasma dermis, resulting in increased melanogenesis.

Here are some facts about the risk factors associated with melasma/chloasma:

• Melasma is much more common in women during their reproductive years, but it does occur in men, who make up about 10 percent of melasma cases.
• The average age of onset for Melasma ranges between 20 and 30 years.
• Chloasma can affect pregnant women of any race, but it’s much more common among women with darker skin types than those with lighter skin.
• A familial history of chloasma may increase your risk of developing the condition.
• Chloasma is most common in people of Asian and Hispanic origins.

Conventional Treatment options:

Many topical medications are used to treat the various stages of Melasma, including the following:

• Hydroquinone: This is the most commonly prescribed topical agent. It’s used to lighten dark patches on the skin. Long-term hydroquinone use can lead to adverse side effects, including depigmentation (lightening of the skin) and blue-black pigmentation (exogenous ochronosis).
• Azelaic acid: This is often recommended as an alternative to hydroquinone for skin pigmentation treatment.
• Kojic acid: It is made from different fungi and is used in cosmetic products as a skin-lightening agent. For some people, it can lead to contact dermatitis and make your skin more susceptible to sunburn.
• Retinoids: Retinoids like tretinoin are commonly used in photoaging therapy to reverse skin aging. However, some patients experience irritant reactions when using retinoids, including burning, scaling, and dermatitis. 
• Topical steroids: Topical corticosteroids are commonly used in conventional medicine for various skin conditions because of their anti-inflammatory properties. They are sometimes used in combination with hydroquinone to suppress melanin production. 
• Glycolic acid: Glycolic acid is often used in chemical peels or depigmentation peels. It is a powder made of crystals, so it’s commonly added to cosmetic products as an exfoliating agent.
• Mequinol: Mequinol is often used in combination with a topical retinoid called tretinoin for skin depigmentation. But mequinol should not be used by pregnant women because it may cause birth defects.
• Arbutin: Arbutin is extracted from the bearberry plant, is used to prevent the formation of melanin, and is commonly added to skin-lightening products. However, there’s not enough evidence to fully understand the mechanisms of arbutin for skin care.

Natural Treatment Options: 

1. Protecting your skin from the sun – As part of your treatment plan for chloasma, it’s important to avoid UV rays, as they can worsen your symptoms. Avoid direct sun exposure throughout pregnancy and regularly use broad-spectrum mineral sunscreen.
2. Homeopathy – Homeopathy works on the principle of increasing the body’s immunity to holistically treat the health issue on the root level. The top 8 natural medicines for facial pigmentation are Sepia Officinalis, Pulsatilla Nigricans, Cadmium Sulphuratum, Berberis Aquifolium, Sulphur, Psorinum, Lachesis Muta, and Thuja Occidentalis.
3. Vitamin C Because of vitamin C, or ascorbic acid’s antioxidant properties, it can be used as a natural remedy for chloasma. It helps to prevent free radical production and the absorption of ultraviolet radiation.
4. Bioflavonoids, or flavonoids, are naturally occurring polyphenolic compounds with well-known anti-inflammatory and antioxidant properties. They can be beneficial when consumed and even when flavonoid compounds are added to skincare products. This is due to their hypopigmentary effects, which come from their ability to affect melanin pigmentation. Increasing your consumption of bioflavonoid-rich foods, such as fresh fruits, vegetables, herbs and spices, teas, and high-quality dark chocolate.
5. Foods high in lutein- a type of carotenoid antioxidant that helps fight free radical damage caused by blue light or sun exposure. Many people know of it as “the eye vitamin,” but it can also help improve chloasma symptoms. The safest way to increase your lutein content is to eat high sources of antioxidants, like kale, collard greens, spinach, broccoli, green beans, eggs, and papaya.
6. Ruling out a zinc deficiency- Researchers found a significant relationship between low levels of zinc and Melasma, as 45.8 percent of patients with the skin condition had a zinc deficiency, compared to 23.7 percent of patients who served as controls. Zinc is typically included in prenatal vitamins, which you should take every day of your pregnancy. You can also increase your levels by eating foods high in zinc, including grass-fed beef, pumpkin seeds, chickpeas, yogurt, and spinach.

Remember: 

Chemical peels and lasers may yield unpredictable results and are associated with adverse effects, including epidermal necrosis, postinflammatory hyperpigmentation, and hypertrophic scars.

These procedures carry a risk of adverse outcomes. Peels use glycolic or salicylic acid-based compounds, which may increase the turnover of hyperpigmented keratinocytes. 

The efficacy of lasers for the treatment of Melasma has been associated with undesired cosmetic results. Their use should be considered in cases of extensive disease refractory to laser use as it may worsen the condition.

So, this was in detail everything you should know if you are looking for a holistic relief from Melasma. 

I hope you gained some fantastic insight about this skin issue and what possible treatment options you have.

If you are dealing with a skin issue and are looking for a holistic cure , book a consultation today.