What are the factors that exacerbate melasma?

Also known as cholasma or "pregnancy mask", melasma is a symmetrical hyperpigmentation of the face, ranging from light brown to dark brown. It occurs during the second trimester of pregnancy in 45 to 75% of women. This appearance of spots is also visible in about a third of women taking oral contraceptives.

Depending on the location of the brown spots, there are 3 types of melasma:

• The centrofacial melasma: The spots are clustered in the T-zone, upper lip, and chin area;

• The malar melasma (the most common): The spots are located only on the nose and cheeks;

• The mandibular melasma: Aggregation of spots on the lower jaw.

Melasma can also be categorised according to the layer of skin affected:

• Theepidermal melasma, which is the most superficial form, with hyperpigmentation of the epidermis;

• The dermal melasma which affects the dermis, the intermediate layer of the skin that is vascularised and contains the essential proteins for firmness and elasticity (collagen, elastin);

• Themixed melasmawhich is characterised by both an epidermal melasma and a dermal melasma.

It should be noted that women with darker skin are at a higher risk of developing melasma. Furthermore, men can also be affected if they are undergoing oestrogen treatment as part of a prostate cancer therapy. According to the American Academy of Dermatology, 10% of melasma cases affect men. This condition can also affect individuals undergoing hormone replacement therapy or those on anti-epileptic medications.