Article 5: Chloasma and Melasma (Facial Pigmentation)

Original Title: کلوا سما ومیلاسما یا لکه های رخسار
Melasma (historically referred to as chloasma when occurring during pregnancy) is a very common, acquired skin condition that causes symmetrical, dark brown or grayish patches to develop on the face. It is particularly prevalent among women, especially those with darker skin tones, though men can experience it as well. Because these patches appear prominently on highly visible areas of the face, the condition often causes significant cosmetic concern and emotional distress.

Common Locations

The pigmentation is typically distributed across three major areas of the face:

1. Centrofacial Pattern: The most frequent presentation, affecting the forehead, cheeks, nose, and upper lip.
2. Malar Pattern: Confined primarily to the cheekbones.
3. Mandibular Pattern: Appearing along the jawline.

Primary Causes and Triggers

Melasma is a complex, multi-factorial condition caused by the overactivity of melanocytes (the cells that produce skin pigment). The primary drivers include:

• Hormonal Fluctuations: Shifts in estrogen and progesterone levels are major triggers. This is why the condition frequently appears during pregnancy (“the mask of pregnancy”) or with the use of oral contraceptive pills and hormone replacement therapies.
• Ultraviolet (UV) Exposure: Sunlight is the most critical environmental trigger. UV radiation stimulates melanocytes to produce excess pigment, which can cause new patches to form or quickly darken existing ones. Even a brief period of unprotected sun exposure can undo months of treatment progress.
• Genetic Predisposition: A family history of melasma increases an individual’s susceptibility, indicating a clear genetic component.

Management and Clinical Treatment

Melasma can be stubborn and requires a combination of strict preventive measures and targeted medical interventions:

1. Rigorous Sun Protection: This is the cornerstone of any successful treatment plan. Patients must wear a broad-spectrum, high-SPF sunscreen daily (ideally containing physical blockers like zinc oxide or iron oxides to protect against visible light) and wear wide-brimmed hats outdoors.
2. Topical Lightening Agents: Dermatologists typically prescribe creams containing active ingredients such as hydroquinone, tretinoin, corticosteroids, azelaic acid, or kojic acid to suppress pigment production and accelerate skin cell turnover.
3. Advanced Procedures: In persistent or severe cases that do not respond well to topical creams alone, specialized procedures can be highly effective. These include:

• Chemical Peels: Utilizing controlled acids to exfoliate the pigmented outer layers of the skin.
• Laser Therapy: Targeted laser treatments designed to break down excess melanin. These must be performed carefully by experienced professionals, as improper laser settings can cause irritation and lead to post-inflammatory hyperpigmentation, making the patches darker.
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