Melasma is often called a “pregnancy mask” because the veil of dark blotchy patches on the face seems to appear when you’re expecting a baby. But melasma doesn’t just occur in pregnant women – the skin condition can appear at any stage of life, including before pregnancy and during menopause.
The ratio of melasma in women versus men is 9:1, and the American Academy of Dermatology says the average age of onset is between 20 and 40 years.
People with deeper skin tones, such as those of Southeast-Asian and South Asian descent, are more prone to developing melasma, said Dr Lee Hwee Chyen, medical director and consultant dermatologist at Epi Dermatology & Laser Specialist Clinic.
Melasma is a complex skin condition, he added. It’s not only influenced by UV exposure and lifestyle factors, but also by genetic and hormonal factors, including medical conditions like thyroid disorder. For some, it can be persistent.
MELASMA IS DIFFICULT TO DIAGNOSE
Dr Lee describes melasma as dark, blotchy patches with irregular borders on both sides of the face. The patches are commonly found on the forehead, cheeks and nose.
There is no diagnostic test for melasma. Instead, diagnosis relies predominantly on the doctor recognising it based on medical guidelines, said Dr S K Tan, founder and medical director of IDS Clinic, an aesthetic clinic.
The problem is that even with such “textbook” guidelines, melasma isn’t that easy to diagnose.
“It is commonly misdiagnosed or overlooked because it can co-exist and/or overlap with other common types of hyperpigmentation, such as post-inflammatory hyperpigmentation, age spots or freckles,” said Dr Lee.
Sometimes, the melasma patches have regular and defined borders, or appear only on one side of the face, which can resemble other forms of pigmentation, said Dr Tan.
HORMONES PLAY A BIG PART IN MELASMA
Hormonal changes play a significant role in the occurence – and recurrence – of melasma.
“Hormonal fluctuations in oestrogen and progesterone, notably during pregnancy, can serve as a catalyst for melasma development, stimulating melanin production and resulting in emergence of dark patches on the skin,” said dermatologist Dr Lee. Melanin is the pigment that gives you your skin tone, as well as your hair and eye colour.
In fact, research has found that elevated levels of oestrogen have been linked to increased skin pigmentation. And because oestrogen is constantly in flux throughout a woman’s life, the chances of melasma recurring is high.
