Chloasma – what is it and how to treat it? Causes and diagnosis of chloasma

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Chloasma is a common skin pigmentation problem that causes dark and uneven skin tones in sun-exposed areas, mainly the face. It occurs more often in women than in men and usually first appears between the ages of 20 and 50 or during pregnancy. While it is medically harmless, discoloration is a cause of embarrassment for many people, so it is common to seek a solution to this skin problem. Chloasma is also called melasma or pregnancy mask.

What is chloasma and what does it look like?

Chloasma is a common skin disease. If we have chloasma, we are likely experiencing light brown, dark brown, and / or blue-gray patches on our skin. They can appear as flat spots or freckle-like patches. Commonly affected areas include the face, including the cheeks, upper lip, and forehead, as well as the forearms. Chloasma is sometimes called the “pregnancy mask” because it often affects pregnant women. Chloasma usually darkens and brightens over time, often worsening in summer and improving in winter.

Another, less common name for chloasma is melasma. While this disorder is completely harmless, it is understandably making some people feel uncomfortable.

See also: Have you noticed dark spots on your face? You may be suffering from chloasma

Chloasma – where is it most common?

Chloasma appears most often on the cheeks, nose, chin, upper lip and forehead. Sometimes it affects the shoulders, neck, and back. In fact, chloasma can affect any part of the skin that is exposed to sunlight. Therefore, most people with chloasma notice that their symptoms worsen during the summer months.

See also: Sun allergy – how to recognize and treat it?

How common is chloasma?

Chloasma is a very common skin disease, especially among pregnant women. These discolorations affect from 15% to 50% of pregnant women. Chloasma can develop between 1,5% and 33% of the population, and it is more common in female reproductive years and rarely in adolescence. It usually starts between the ages of 20 and 40.

See also: Discoloration of the face. 3 ways to remove discoloration

Who is at risk of chloasma?

Fair-skinned individuals are less likely to develop chloasma than those with dark brown skin or those who sunbathe well. Women are more prone to chloasma than men: about 10% of those suffering from chloasma are men and 90% are women. Pregnant women get chloasma more often than anyone else. You should also pay attention to the fact that the risk of developing these specific discolorations increases if you take oral contraceptives and hormones.

Chloasma – how does it affect the skin?

Our skin consists of three layers. The outer layer is the epidermis, the middle is the dermis, and the deepest is the subcutaneous layer. The skin is an organ – the largest organ – and makes up about one-seventh of your body weight. Our skin also has a very important function, as it protects our bones, muscles, organs and everything else from the cold, germs, sun rays, moisture, toxic substances, injuries and more. It also helps regulate body temperature, prevents hydration, allows you to feel sensations such as the warmth of a hot mug, fur when we stroke the dog and the pressure of someone’s hand holding us.

Our epidermis contains cells called melanocytes that store and produce a dark color (pigment) known as melanin. In response to light, heat, ultraviolet radiation or through hormonal stimulation, melanocytes produce more melanin and therefore our skin darkens.

Why do women get chloasma when they are pregnant?

Pregnant women have elevated levels of the hormones estrogen and progesterone. These hormones are believed to contribute to the development of chloasma. The darker color usually fades after pregnancy.

Chloasma – types

There are three types of chloasma and they are related to pigment depth. Wood’s lamp, which emits black light, can be used to determine the depth of the pigment.

1. Epidermal chloasma: The epidermal chloasma is dark brown in color, with a well-defined border, appears clear under black light, and sometimes responds well to treatment.
2. Cutaneous chloasma: Cutaneous chloasma has a light brown or bluish color, a blurred border, looks no different under black light, and does not respond well to treatment.
3. Mixed chloasma: Mixed chloasma, which is the most common of the three, has both bluish and brown patches, shows a mixed pattern in black light, and shows some response to treatment.

See also: Are UV-C sterilization lamps a good way to disinfect from the coronavirus?

Is chloasma permanent?

Chloasma is a typically chronic disease. This means that it is long-lasting (three months or more). Some people have had chloasma for years or for life. Other people may only suffer from this condition for a short time, such as during pregnancy.

Is chloasma painful?

Chloasma is harmless. It is in no way painful, itchy or unpleasant.

Chloasma – causes

Chloasma develops when there is an excess of melanin in certain areas of the skin. Melanin is the substance that gives the skin, eyes and hair color. Dark-skinned people have skin that produces more melanin; lighter skinned people have less melanin.

Melanocytes are cells in the skin that produce melanin. For reasons that are not entirely clear, these cells sometimes malfunction and begin to produce more melanin in some areas than in others. The excess melanin produces dark, stained areas we know as chloasma

In the case of chloasma, discoloration mainly affects the epidermis, i.e. the highest layer of the skin. However, there is growing evidence that although the discoloration is located in the epidermis, the deeper layers of the skin (the dermis) also play a role in the development of chloasma.

Trigger factors

There are certain factors that make us more prone to developing chloasma. The more of these factors we have, the more likely chloasma is to develop. However, in some cases, chloasma develops without an apparent trigger.

Shame and shame

If our complexion is olive, medium or medium dark and we tan very easily, we have a greater chance of developing chloasma than people with very light or very dark complexion. People who are most at risk of developing chloasma are those whose skin is between XNUMX and XNUMX on the Fitzpatrick scale (a method of measuring skin tone, where I is the lightest complexion and VI is the darkest complexion). This problem is not so common in skin types that are at the extreme end of the spectrum.

Shame and hormones

The development of chloasma is associated with increased estrogen hormones. This explains why chloasma is much more common in women than in men. However, men can develop the condition, especially if someone in their family has had problems with chloasma. Since thyroid problems affect our hormones, we also have a better chance of developing chloasma if we have thyroid problems.

Chloasma and pregnancy

Chloasma is also called the “pregnancy mask” for a reason. It is estimated that chloasma affects up to 70% of pregnant women, appearing in the second or third trimester. Again, elevated levels of estrogen and progesterone are to blame here.

Chloasma and sun exposure

Another important factor in triggering the development of chloasma is overexposure to the sun. In fact, we can see that chloasma looks more prominent in the sunnier summer months and fades slightly in winter. The sun’s ultraviolet rays stimulate the melanocytes to produce more melanin. In people with chloasma, the dermis shows signs of prolonged sun exposure and sun damage.

Chloasma and genetics

Some may be genetically predisposed to developing chloasma. The overwhelming number of people with chloasma also have relatives with this problem. So, if someone in our family has suffered from chloasma, we should do everything we can to limit other triggers when possible.

Chloasma and dermatitis

Cosmetic procedures that trigger skin inflammation, such as chemical peels and laser treatments, can also trigger the development of chloasma in some people

Chloasma and medicines and cosmetics

Certain medications can increase your risk of developing chloasma. This list includes birth control pills and hormone replacement therapy (because they increase estrogen levels), antiepileptic drugs and tetracyclines. In addition, any cosmetic products that make our skin more sensitive to the sun can increase the risk. However, none of them are considered primary risk factors.

Chloasma – symptoms

Chloasma causes discoloration that is darker than the surrounding skin. The skin looks blotchy and uneven, with irregular boundaries of discolored patches. Discoloration can range from slightly darker than normal skin color to very dark. Depending on the skin tone and the severity of the chloasma, the discoloration can range from light brown to almost black.

The stains are flat, not convex. They don’t hurt, burn or itch. In fact, we won’t notice anything else about these areas of skin, except that they are discolored.

Chloasma develops on sun-exposed areas of the skin, most often on the face. Above the upper lip, cheeks, nose, and forehead are very common areas where it can be found, but chloasma can develop anywhere on the face. It can also develop on the chest, arms, and upper back, although not so often.

The key factor with chloasma is that it tends to appear symmetrically on the face. We will notice “matching” patches on both cheeks, or patches that have developed evenly on the nose or forehead.

See also: Stains on the body – types, causes

Chloasma – diagnosis

The diagnosis of chloasma is made through a simple visual inspection by a physician. A specialist can also look at our skin under a Wood’s lamp to see the range of pigmentation more easily.

Wood’s lamp is a kind of black light. It illuminates the skin and allows the technician to easily spot discoloration and sun damage compared to normal skin. Wood’s lamp reveals sun damage to the skin’s surface as well as damage that is deeper and invisible to the naked eye.

It’s very rare for a doctor to perform a biopsy of the affected area to confirm it’s chloasma. This is only done when the question arises if it could be another skin problem.

Chloasma is an extremely common cosmetic problem. The condition is not a precancerous skin condition, which means it will not turn into skin cancer. (However, overexposure to the sun, which is a trigger for the development of chloasma, increases the risk of skin cancer. So it’s always a good idea to wear sunscreen). Chloasma is also not contagious.

Other conditions that cause skin discoloration

There are many skin conditions that cause discoloration (darkening of the natural color of the skin). Most of them are fairly easy to distinguish from chloasma, but some may look very similar, especially if you’re unfamiliar with them.

Chloasma and age or liver spots

Often called liver spots, age spots, or sunspots, the technical term for this type of discoloration is lentil spots. Lentil spots are round, oval, sometimes irregular, dark spots. Like chloasma, lentil spots are flat areas of discoloration that develop on sun-exposed areas of the skin. The difference is that chloasma generally covers a larger area and develops symmetrically on the face. Lentil stains are more common on fair skinned skin.

See also: Allergy to the sun

Chloasma and post-inflammatory discoloration

The key difference between post-inflammatory hyperpigmentation and chloasma is the underlying cause. Post-inflammatory hyperpigmentation develops after some type of inflammatory wound: cut, scratch, burn, eczema, or acne. This is not a scar, but rather a flat area of ​​discolored skin left behind after the skin has healed.

Chloasma and freckles

Ephelids are more known to us as freckles. Freckles also develop from sun exposure and some skin types are more prone to it. They look as if they are “sprinkled” over the skin, not in large patches such as chloasma.

Chloasma – treatment

Chloasma is not a harmful condition; this is entirely a cosmetic problem. If it doesn’t bother us, we can leave her alone. There is no medical reason to treat it.

In some cases, discoloration may fade over time. This is most likely if you developed chloasma during pregnancy.

However, if we decide to treat it, we have several options:

Chloasma – prescription topical medications

Topical prescription medications are the cornerstone of chloasma treatment. Depending on what our doctor decides what is best for us, we may be prescribed:

1. Hydroquinone (sometimes in combination with kojic acid);
2. Topical corticosteroids;
3. Tretynoina;
4. Azelaic acid;
5. Tranexamic acid.

An oral prescription drug called tranexamic acid is effective in treating chloasma but has risk factors. Let’s ask our doctor if this is the right method for us.

Shame — products without prescriptions

While over-the-counter products are not the most effective options for treating chloasma, they can help fade discoloration over time, especially if the discoloration is rather minor. They can also be used as a grooming method after achieving good results with other treatments. They include:

1. Glycolic acid;
2. Licorice extract;
3. Vitamin C (L-ascorbic acid).

Chloasma treatments

In some cases, in-office procedures can be used to treat chloasma. They are often used alongside other topical therapies. They include:

1. Microdermabrasion;
2. Chemical peels;
3. Laser treatments.

Chloasma and sun protection

Whichever treatment option you choose, there is one key step that must not be missed: sun protection. The sun has a great influence on the development of chloasma. No treatment will be effective if we do not protect the skin from the sun.

Sun protection doesn’t stop when chloasma treatment ends. Once we reach the point where we are satisfied with the results of the treatment, we still urgently need to use sunscreen. Even a few hours of exposure to the sun without protection can aggravate the recurrence of chloasma.

Use sunscreen with a concentration of SPF 30 or more every day (tinted sunscreen is fine). We should use sunscreen every day as part of our skincare routine, even when it’s cloudy or we spend little time outdoors.

If we intend to be outside for long periods, make sure to apply sunscreen frequently. It is also a good idea to wear a hat.

Needless to say, you should not sunbathe, neither in the sun nor in a solarium, if you are trying to improve the condition of chloasma. We especially don’t want to sunbathe when we’re pregnant as we’re more prone to developing chloasma during pregnancy.

See also: Which sunglasses to choose? Important advice from an ophthalmologist

Chloasma and coping with the disease

Chloasma does not have to bother us at all. However, it can also be the cause of our incredible embarrassment or embarrassment. No matter where we are on the spectrum, our feelings are normal. It’s normal to feel frustrated with our treatments and sometimes with their actions, and with the results we get (or don’t get).

Undoubtedly, chloasma is difficult to treat. Here are some tips to help us when we feel discouraged or uncomfortable.

1. Let’s use our treatments exactly as recommended. Consistent treatment is the key to getting the best results. If we are unsure, let’s ask our doctor to explain.
2. Let us give the treatments enough time. Chloasma disappears slowly over a long period of time. We won’t see the results right away. Try to be patient and expect treatment to last at least a few months.
3. We should always protect our skin from the sun. This is especially important when treating chloasma. Use sunscreen and wear protective clothing such as a hat.
4. Let’s not scratch. This may seem counterintuitive, but scratching the skin is not recommended. Scratching or scrubbing the skin will not remove the discoloration and can worsen it by irritating the skin and causing inflammation.
5. Let’s try corrective makeup. A regular foundation or concealer can reduce discoloration and make them less visible. If we want to mask completely, try masking makeup or corrective makeup. This type of makeup has been specially formulated to completely cover all kinds of skin imperfections, from scars, vitiligo, tattoos, birthmarks and chloasma.
6. Let’s be prepared for some kind of long-term treatment. Chloasma is often a stubborn disease. Topical products can keep the discoloration in check, but if we stop using them, the discoloration will reappear. Regular, long-term use is your best defense to stop chloasma. Our dermatologist will help us develop the best long-term treatment plan for our skin.

Do some foods affect chloasma?

At present, experts do not know that any food or drink directly causes, treats, or worsens chloasma. However, to keep your skin healthy overall, it’s a good idea to follow a skin-healthy diet rich in vitamin D. Recommended foods for this diet include:

1. Almond milk;
2. eggs;
3. meat;
4. milk;
5. mushrooms;
6. oily fish;
7. Orange juice;
8. yogurt.

See also: Some good reasons why you should eat eggs