Melasma: The Mask of Pregnancy

Melasma is probably the most common pigmentary abnormality in women. The average age of onset is in the early 30s. Almost half the sufferers from melasma have family members who also have melasma. This condition most commonly starts during pregnancy, but it may also start before or after pregnancy. Much less commonly, it can be seen in males. Melasma is more common in women with darker skin types, and more time spent outdoors during pregnancy is associated with an increased risk of melasma. Inreased maternal age at first pregnancy and multiple pregnancies both increase the risk of melasma. Birth control pill use is another factor that has been associated with the onset of melasma.

The treatment of melasma can be difficult. Sun avoidance is imperative. It's the ultraviolet A that makes melasma worse, and many sunscreens do not block Ultraviolet A well. No sunscreen works as well as shade. Bleaching creams containing hydroquinone have been the mainstay of melasma treatment in the past, and these are still used today. TriLuma is currently the most powerful of the prescription bleaching creams, but it has some risks due to the fact that it contains a relatively powerful topical steroid.
Lasers have come to play a bigger role in the treatment of melasma, and we have had success with both the Fraxel Restore and the Medlite NdYAG laser. However, it's important to understand that there is no treatment that works all the time, and sometimes nothing will work.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA