Melasma is much more than a cosmetic complaint, said Seemal R. Desai, MD, FAAD, clinical assistant professor in the department of dermatology at UT Southwestern Medical Center in Dallas, Texas, during Virtual Media Day. the Skin of Color Society, held in November. 9, 2021. Instead, he emphasized the chronic nature and acute psychological impact of melasma.

The characteristic light brown, dark brown, and/or blue-gray patches on the skin may appear as flat spots or freckle-like patches. Melasma typically affects the face, including the cheeks, upper lip, and forehead, as well as the forearms.1

The most common melasma triggers include:2.3

1. SUN EXPOSURE
UV light has been shown in clinical and laboratory studies to trigger and exacerbate melasma. “UV light is thought to induce reactive oxygen species (ROS) by activating inducible nitric oxide and promoting melanogenesis,” wrote the authors of a study published in Dermatology and Therapy.3 “Melasma patients also have higher markers of oxidative stress. A seminal study showed sustained visible light pigmentation in darker skin types over 2 weeks compared to UVA-1 light pigmentation. The authors also highlighted their finding that keratinocytes and fibroblasts can stimulate the process of melanogenesis after exposure to UV and visible light.”One of the major pathways of UV and visible light-induced pigmentation is the secretion of stem cell factor (SCF), the tyrosine kinase receptor ligand, c-kit, which leads to downstream effects on melanocyte proliferation,” the authors wrote.

2. HORMONAL CHANGES
The skin disorder is also called the “pregnancy mask”. Data shows that 15% to 50% of pregnant women have melasma, according to the Cleveland Clinic.1 Additionally, up to 33% of the general population may contract melasma during their lifetime, usually during childbearing years, but rarely during puberty.1

3. FAMILY HISTORY

This is a known risk factor – studies have reported that 55% to 64% of patients with melasma have a positive family history.

4. THYROID DISEASE

Researchers have looked into an association between endocrinological conditions, such as thyroid disease, and melasma, but this area requires further analysis and study. People with skin of color (SOC), such as those of Latino, Black, Asian, Indian, Middle Eastern, or Mediterranean descent, are more likely to have melasma.1 The skin disorder occurs when melanocytes overproduce. People with SOC have more active melanocytes than people with fair skin, which increases the likelihood of the disease.2

Approved treatments include hydroquinone, tretinoin, corticosteroids, and other synthetic and natural topical compounds that have shown varying effectiveness. Aesthetic procedures such as chemical peels, microneedling, radiofrequency and laser treatments are also used as mono- and combination therapies.4 “It’s important to understand that this is a chronic condition that has relaxing episodes,” said Janiene Luke, MD, associate professor in the Department of Dermatology and residency program director at Loma Linda University. in California, who spoke with Desai during the Media Day virtual panel. “Despite cosmetic procedures and medical prescriptions, this condition can flare up from time to time.”

For many Asian patients, unapproved skin bleaching creams are also a popular and dangerous treatment option. “There is, in my opinion, a worldwide epidemic of skin bleaching and this desire for skin to become white, luminous and clearer,” Desai said. “Many of these long held beliefs in many cultures are due to decades and centuries old beliefs that have led people to continue to perpetuate the myth that lighter skin is more beautiful and acceptable skin.” Skin whitening or “whitening” creams accounted for approximately 80% of India’s $1 billion moisturizer market in 2019. In 2020, the global market was worth $8.6 billion, with forecast demand reaching $12.3 billion. billion by 2027.4.5

Mercury continues to be the most dangerous ingredient found in skin lightening products. Using mercury-containing products can lead to kidney damage, peripheral neuropathy, scarring, and depression, among other serious health consequences.6.7 Although some consumers are moving away from whiteners containing ingredients such as toxic mercury, whiteners marketed as natural, including glutathione, remain standard treatments in medical spas in the Philippines.6 The use of the products persists even after the Philippines Food and Drug Administration (FDA) issued several warnings about the use of injectable glutathione as a skin bleaching agent.8 “[Although] ingredients can be called natural or botanical, that doesn’t always mean they’re safe and effective,” Desai said. “For example, patients receiving IV infusions of glutathione and intravenous fluid for skin lightening have become extremely popular, [despite] warnings from the FDA here in the United States and from the FDA in the Philippines and other countries, where it’s happening. IV glutathione infusions have [been] have been shown to be dangerous and cause Stevens-Johnson syndrome, sepsis and even death in some patients.

Desai also highlighted a specific product, previously called Fair & Lovely, which caused major controversy following the 2020 civil unrest and Black Lives Matter protests in the United States. “The name alone tells you [that] the lighter your skin, the more beautiful it is,” he said. “But the image on the product is of a darker skinned Indian or Asian woman becoming lighter and brighter after using this product. Due to the tragedies of 2020, Unilever actually received an immense amount of backlash for this product.9 The name was changed to Glow & Lovely.

The references

  1. Melasma. Cleveland Clinic. Accessed January 7, 2022. https://my.clevelandclinic.org/health/diseases/21454-melasma
  2. Melasma: who obtains and causes. Association of the American Academy of Dermatology. Accessed January 7, 2022. https://www.aad.org/public/diseases/az/melasma-causes
  3. Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatol Ther (Heidelb). 2017;7(3):305-318.doi:10.1007/s13555-017-0194-1
  4. Chuwirch P, Makol MK, Saxena R. Skin whitening products are still big business in Asia. Bloomberg Business week. September 22, 2021. Accessed January 7, 2022. https://www.bloomberg.com/news/articles/2021-09-22/skin-whitening-creams-remain-big-business-in-asia-despite-purge
  5. Skin Lighteners: Global Market Trajectory and Analysis. StrategyR. Accessed January 7, 2022. https://www.strategyr.com/market-report-skin-lighteners-forecasts-global-industry-analysts-inc.asp
  6. Mercury poisoning linked to skin products. US Food and Drug Administration. Updated November 23, 2021. Accessed January 7, 2022.https://www.fda.gov/consumers/consumer-updates/mercury-poisoning-linked-skin-products
  7. Araneta P. The dark side of skin lightening. She Canada. October 22, 2021. Accessed January 7, 2022. https://www.ellecanada.com/beauty/skincare/the-dark-side-of-skin-lightening
  8. Dangerous use of glutathione as a skin lightening agent. Philippines Food and Drug Administration. July 5, 2019. Accessed January 7, 2022.https://www.fda.gov.ph/wp-content/uploads/2019/07/FDA-Advisory-No.2019-182.pdf
  9. Unilever is evolving its skincare portfolio to embrace a more inclusive view of beauty. Unilever. Press release. Published June 24, 2020. Accessed January 7, 2022. https://www.unilever.com/news/press-and-media/press-releases/2020/unilever-evolves-skin-care-portfolio-to-embrace-a-more-inclusive-vision-of-beauty/