Melasma and menopause: what you need to know

Melasma is a skin condition causing patches of pigmentation, usually on the face
Hormone changes in pregnancy and menopause can aggravate the condition
Management approaches include sunblock, topical creams and laser therapy

As temperatures climb over the summer, heading outside gets all the more enticing. But sun is one of the factors that contributes to melasma, a skin condition where brown or greyish patches of pigmentation develop, usually on the face.

Here Consultant Dermatologist and balance guru Dr Sajjad Rajpar shares what you need to know about the condition, what causes it, the role of hormones, and what you should do.

What is melasma?

Melasma is a common skin condition when patches of skin, often on your face, develop a brown or greyish pigmentation.

Which areas tend to be affected?

Melasma mainly develops on your cheeks, forehead, upper lip, nose and chin. But it can affect any area of your face and also other areas of your body exposed to the sun, such as the forearms and neck. Areas of melasma are flat, not raised.

Who is at highest risk?

It is much more common in women, who account for between 80 and 85% of cases, says Dr Rajpar.

Up to 50% of women are affected during pregnancy, hence the name ‘pregnancy mask’, according to the British Association of Dermatologists (BAD).

Sometimes men are affected, but much less frequently. Melasma is more common in people of colour and those who tan very easily, says BAD.

What causes melasma?

The exact cause is not known, but it is thought to be because of pigment-producing cells in your skin called melanocytes producing too much pigment (melanin).

The three main factors which seem to contribute to the condition are genetics, those with a family history have a higher risk, sun exposure and hormones, says Dr Rajpar.

‘Melasma is not just a skin discolouration problem,’ he says.

‘It’s a really complex, chronic, inflammatory, serious skin condition. It can seriously affect the quality of life of the people who develop the condition and it can impair social comfort because of the appearance of it. When I see patients with melasma I try and explain that it is not like a tan. The sun is just one factor.’

What about the sun?

Sunlight is an important factor in stimulating your melasma.

Dr Rajpar says patients mostly present with with melasma between April and July. This is because the ultraviolet (UV) light and the visible light in the sun triggers or worsens the condition, by stimulating pigment production.

‘Melasma is not caused by the sun, but it’s aggravated and worsened by it,’ Dr Rajpar says,

What role do my hormones play?

Your hormones seem to play a role in causing melasma, although it is not yet understood exactly how.

But some women’s skin patches are triggered by times when hormones change: pregnancy, starting the contraceptive pill or using HRT can all start or trigger the condition.

‘So we don’t really know what the exact mechanism between hormones and the skin are, but there is definitely a relationship between hormones and melasma,’ Dr Rajpar says. ‘It seems to happen when levels of hormones are higher.’

How can melasma be managed?

First of all, invest in a good broad-based sunblock that is tinted, which means it contains iron oxide, says Dr Rajpar. This will protect you against both UV light and visible light.

Then be absolute scrupulous about its use, as even a short exposure to sunlight can undo your hard work.

‘Sunblock is really crucial and for some people, sunblock may be enough,’ he says. ‘So meticulous sun protection, and I do mean meticulous, sun protection. Even 30 seconds of UV exposure can trigger the condition.’

What else can I use to treat my melasma?

There are a number of different products that can help reduce the impact of melasma:

Hydroquinone is the most commonly prescribed product, says Dr Rajpar. It works by reducing the production of dark pigmentation in your skin.

It comes mixed with two other products, tretonin and a steroid, to become what is called the triple formula or Kligman’s formula. This can only be used for three or four months but is effective in about 60 to 70% of people, Dr Rajpur adds.

Azelaic acid is a good maintenance product after you have used hydroquinone to help prevent melasma returning. It is a cream and can be bought over the counter.

Cysteamine is a product that also works well for maintenance. It helps block the production of melanin and also works as an antioxidant, which may also have an impact on your malfunctioning pigment-producing cells. This product, which you put on your face for five to 15 minutes a day and then wash off, is also available over the counter.

In addition, there are botanical products derived from plants including soy and liquorice, that may have some anti-pigmentary effects.

‘But in my experience, they’re not as effective or as powerful as your hydroquinone, your azelaic acid and your cysteamine,’ says Dr Rajpar.

‘And I would say that’s my top three when it comes to topical skin care.’

What about in-clinic treatments?

There are a number of in-clinic treatments, such as laser therapy, which are sometimes used alongside topical creams.

These treatments are not usually available on the NHS, so Dr Rajpar recommends that if you are considering this kind of approach for melasma you need a proper medical assessment from a doctor, rather than seeking care for this complex condition at a high street beauty therapist.