Melasma Reasons

Most of the time, melasma reasons are hormonal, especially due to hormonal changes. However, whatever the reason, the sun plays the most significant role. If you expose your face to the sun, it can worsen melasma. Now, let’s first explore the melasma reason.

The primary cause is an increase in the levels of estrogen and progesterone, which elevates a hormone called melanocyte-stimulating hormone. This, in turn, leads to an increase in melanin pigment production in our cells. As this condition is more common in females, especially during pregnancy, almost 20% to 50% of women are affected by melasma.

We also need to address other common melasma reasons, especially if it occurs in someone who is not married. This can include a history of taking oral contraceptive pills for various reasons or thyroid abnormalities, such as hypothyroidism, which increases the likelihood of developing melasma. Additionally, it can sometimes be associated with nutritional deficiencies, like iron deficiency.

These are the different melasma reasons, and they need to be addressed through various treatment modalities.

The significant causes of melasma are the use of birth control pills, the hormones estrogen and progesterone, some medicines during pregnancy, sunlight exposure, and hereditary factors. Although the prevalence of melasma is relatively higher in women than in men, it depends on race, age, and gender.

If we describe the causes in percentage terms, we find:

(a) Hormonal factors:

1. Pregnancy: 30-60%
2. Estrogen and progesterone variation: 9-20%
3. Abnormalities of the thyroid gland: 58%

(b) Hereditary factors:

1. Sun-induced: 100% of cases
2. Cosmetics: more than 80%
3. Medicine: unknown

More than 20% of patients report a hereditary link. Pregnancy and sun exposure increase sunspots. Sunspots are more common in tropical and subtropical countries where sunlight is intense. They may appear in the second and third trimesters of pregnancy, gradually decrease after delivery, and increase in subsequent pregnancies.

Types:
By examining them with a special type of lamp (known as Wood’s lamp), sunspots can be divided into four types, namely:

1. Epidermal:
   This type of sunspot is brown in color, and the spots become more visible when viewed with the lamp. 70-75% of patients fall into this category. The most success is achieved in treatment at this stage.

2. Dermal:
   These spots can be small or large in size and appear dark brown or purplish-brown under the lamp. Their treatment can be very successful.

3. Mixed:
   The spots are dark brown in color and may appear unchanged in some areas under the light. Diseases in this category respond slowly to treatment, with 10% of patients falling into this stage.

4. Indeterminate:
   This type occurs in very dark-skinned individuals. Melasma can only be seen under natural light, with no change observed under the lamp. 5-6% of patients fall into this category.