Melasma – The Black Butterfly

Very often in our practice we encounter women and sometimes men, who complain of the persistent black patches on their cheeks, nose, forehead or chin, which doesn’t seem to go away in spite of taking treatment. This leaves the patients mostly frustrated and often looking for a quick easy fix. These persistent black patches are referred to as Melasma or Chloasma or Mask of Pregnancy. Melas in Greek means Black. It is basically acquired hypermelanosis of sun-exposed areas.

The most important component for our skin color – is the pigment Melanin or the lack of it. In Melasma there will be an increase in the melanin synthesis and melanin deposition presenting as dark patches on the face.

The exact cause of Melasma is said to be unknown. It commonly affects women, but is also seen in 10 % male population. In woman, it is said to be linked to their hormonal activity.

It mostly presents in women who are pregnant or on contraceptive pills or those who have a genetic predisposition in their families. It also worsens on increased sun exposure.

The areas most commonly affect are the cheeks, chin, forehead and upper lip. Sometimes the patches are light or dark brown color – which means the pigmentation is mostly superficial involving the upper layers of the skin. However, when it is a blue gray color – it means that the pigmentation is deeper. Some patients also present with a combination of these two types of pigmentation. It’s important to know this because, the superficial pigmentation responds better to any treatment modality.

The diagnosis is mostly based on the patient’s history or clinical presentation. If required other diagnostic tools like Dermascope, Wood’s Lamp, Biopsy can also be done. Another way to assess the progress of the condition is using the MASI (Melasma Area and Severity Index) – which clinically quantifies the severity of the facial melasma. So the response to treatment can be evaluated by the doctor and the patient on visual examination.

Treatment includes avoiding the triggering factors, taking strict sun protection using sunscreens, topical creams, chemical peels, Fraxel laser. Patients should follow strict sun protection to achieve the maximum result.

The take home message is that, Melasma in spite of being a relapsing condition and can always be kept controlled with treatment and sun protection.