Much Ado About Melasma


While suntanning can give some people the sun-kissed look they want, it may turn for the worse for others and cause undesirable ‘pekas’ on their faces

By Hester Gail Lim-Bueser, MD & Zharlah Gulmatico-Flores, MD

Jane would never forget that fateful day at the beach. It had been an impromptu trip, but, mindful of the sun, she had remembered to slather her family in sunblock before leaving home. She had planned to stay in the shade, but her children had called her to join them in the water. It was the last weekend of summer, and, beckoned by their laughter, she had decided to join them. Later that day, as she observed her reflection, she noticed what looked like new freckles on her cheeks. What she saw that evening would darken over the following weeks into two irregular brown patches—very visible on her otherwise fair skin.

Melasma is common enough in our society that you likely know somebody like Jane, or perhaps her story is similar to yours. Commonly referred to as ‘pekas’, melasma is a skin condition characterized by patchy pigmentation on the face, and sometimes the arms. Melasma primarily affects certain populations, and this is highly dependent on a combination of risk factors and exposure. Skin types in the middle of the skin color spectrum, which encompasses the majority of Filipinos, are particularly susceptible. While it must have felt like it to Jane, melasma does not occur in a day. It is often the product of years of unseen sun damage, surfacing in mid to late adulthood.

Although melasma occurs in men, it affects women disproportionately, because female hormones (estrogens, in particular) can predispose to the condition. Hormonal fluctuations in pregnancy, for example, trigger melasma so frequently that the medical term chloasma, or ‘the mask of pregnancy’ was coined. In some women, taking oral contraceptive pills also increases the risk for melasma, for the same reasons. Like many skin conditions, melasma is strongly determined by genetics. If it appears prevalent among members of your immediate family, there is a strong chance your skin may behave similarly.

The most important risk factor of all, however, is one we are exposed to day in and day out: sunlight. Not only is this the most significant risk factor, sun exposure is also the only modifiable risk factor—that is, the only risk factor that we have significant control of. In recent years, tanning has become increasingly en vogue in the Philippines, a far cry from a decade or two ago. While an even, sun-kissed glow may seem appealing, the pigmentation caused by melasma is irregular and unflattering. Living in the tropics, it would be impossible to avoid the sun completely. So what can we do to prevent the repercussions of sunlight on the skin?

There’s an age-old proverb that applies to melasma: an ounce of prevention is better than a pound of cure. Applying sunscreen generously and frequently is the best way to decrease the risk associated with sun exposure. In addition to protecting from unwanted pigmentation, sunscreens also protect the skin from harmful ultraviolet rays that can lead to skin aging and skin cancer. Sunscreens are far from perfect, however, and it’s best to keep in mind that not all sunscreens are created equally.

The American Academy of Dermatology recommends sunscreens with an SPF of at least 30, with broad spectrum protection and water resistance. The amount of sunscreen required to achieve the promised SPF on the label is an ounce for the whole body—literally ‘an ounce of prevention’, although less is needed when fully clothed.

To cover your face, you need a dollop of sunscreen approximately the size of a 25-centavo coin. Reapplying is important—ideally done every 2 hours, especially when outdoors or doing any heavy activity. Jane from our story remembered to put on sunscreen but failed to reapply.

The skin is a dynamic organ, and sunscreen loses potency over time as it mixes with sweat and oils from the skin. Even with perfect sunscreen use (2 mg of sunscreen per square centimeter of skin!), dermatologists still recommend sun avoidance, and seeking shade especially when the sun is at its peak. If your shadow is smaller than you are, seek shade.

Melasma is a treatable condition, although it may come back. Medications prescribed for melasma include Vitamin A derivatives, such as tretinoin and other related products. These medications increase the turnover of skin, thereby allowing pigmentation to disappear more quickly. Hydroquinone, its derivatives (bearberry and arbutin), and products like kojic acid work to prevent new pigment from forming within the skin. Chemical peels and laser treatments are helpful, particularly for more severe cases.

Each treatment, whether topical or procedural has risks and side effects, so its important to work closely with your board certified dermatologist. Heavy duty cosmetic concealers can add to the protection provided by sunscreen, and helps improve the overall cosmetic appearance of melasma.

Although melasma is easily brushed off as a cosmetic concern, it can have profound psychosocial effects. As social creatures, it’s in our nature to communicate with our appearance. Conditions that affect how we look can affect self-esteem and confidence. In a time when everything we do is meticulously documented and uploaded for the world to see, personal appearance is linked to self-esteem now more than ever.

Preventing a condition as potentially debilitating as melasma only takes a few simple steps, ones which you can initiate yourself. Adding sunscreen to your daily routine is simply a part of basic skin care—and basic skin care is self-care. Invest in prevention.

“Adding sunscreen to your daily routine is simply a part of basic skin care—and basic skin care is self-care”

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