Pigmentation - unmask the mask

Melasma is a skin condition that manifests as brown patches on the forehead, cheeks, nose and upper lip. It occurs primarily in women, being commonly associated with pregnancy, oral contraception, hormone replacement therapy and sun exposure. Over 30% patients have a family history.

Broad spectrum sunscreens with an SPF over 30 protecting against both UVA and UVB rays are essential. Chemical peels, microdermabrasion and laser surgery may help but may equally harm by causing irritation and aggravation. Besides, pigmentation can recur upon sun exposure and/or hormonal imbalance.

Two points to remember are that treatment is a slow process, usually taking several months or more, and that results depend upon the depth of pigmentation. Epidermal melasma (where pigment is located superficially in the upper skin layer) is much more successfully treated than dermal melasma (where pigment is deeply embedded) and whose treatment basically helps to control any spread.

I recall the case of Rashmi, a 35-year-old business woman who came to us with hyper pigmentation on her cheeks and forearms developed during pregnancy. Regarding it as a cosmetic problem, she had tried all sorts of facial creams and cleansers and was even contemplating laser surgery. Our woods lamp examination revealed that the pigmentation on her cheeks was epidermal while that on the forearms was dermal. Accordingly, we advised that the facial pigmentation could be successfully treated whereas the forearm pigmentation could be prevented from spreading but not completely cured. Technology like woods lamp is invaluable in accurately diagnosing such cases. After a few doses of Sepia, Rashmi was delighted to find her hyper pigmentation fading and she now faces the future with confidence.

Article by Dr Mukesh Batra
L.C.E.H., F.H.M.A. (U.K.), F.R.S.H. (Med) P.(Lon), M.D.H. (U.S.A.), F.B.I.H.(U.K.)
Published in Hindustan Times on 17 January 2009