Melanin is the primary pigment producing brown coloration of the skin. Melanin is formed from tyrosinine, via the action tyrosinase (an enzyme) in the melanosomes (they are like small envelopes of pigment) of melanocytes. The melanosomes are transferred from a melanocyte to a group of keratinocytes (they are cells of the first layer of the skin – the epidermis) called the epidermal melanin unit. The variations in skin between persons and between races are related to:

  1. The degree of melanization of melanosomes (darker skins have more melanin).
  2. The number of melanosomes (darker skins have more melanosomes).
  3. The distribution of melanosomes in the epidermal melanin unit.

Chloasma is an extremely common condition characterized by brown patches especially on the maler prominences and forehead.

There are three clinical patterns:

  1. Centro-facial
  2. Malar (cheekbone area)
  3. Mandibular (jawbone area)

It tends to affect darker-complexioned individuals and is seen most frequently in young women. Men make up 10% of reported cases.

Causes:

  • Sunlight exposure (the most important cause)
  • The use of birth control pill (discontinuing the use of contraceptives rarely clears the pigmentation and it may last for many years after discontinuing them)
  • Pregnancy (this usually clears within a few months of delivery)
  • Ovarian disorders (rare)
  • Endocrinology disorders (rare)

We have the following therapeutic options depending on skin type, extent of pigmentation, resistance to cost factors:

  1. Daily and effective sun protection e.g. Photoderm Max SPF100
  2. Hydroquinone: Kligman Formula: Higher concentrations mixed at chemist 3. Skinoren Cream
  3. Kojic Acid
  4. Rucinol
  5. The above mentioned medicines can be used in combination with Chemical Peels:
    • Lactic Acid Peel
    • Glycolic Acid Peel
    • Jessner’s Peel (also a great peel for acne patients)
    • TCA 20% Peel which is controlled TCA (trichlor acetic acid) peel
  6. Microdermabrasion (crystal) - this can be extremely effective in conjunction with the topical bleaching agents
  7. Fractional Resurfacing of the skin

We always try the best medical therapy first and then the patient has the option (if there is a poor response) to go for either microdermabrasion or a chemical peel.