Chloasma: Causes, Signs and Symptoms, Diagnosis Prevention, and Treatment
Introduction to Chloasma
Chloasma, also known as Melasma or the “mask of pregnancy”, is a common skin pigmentation disorder characterized by dark, brownish patches on the face. These patches typically appear on the cheeks, forehead, nose, and upper lip, giving an uneven and blotchy appearance. Though it can affect anyone, Chloasma is more prevalent in women, especially during pregnancy, due to hormonal fluctuations.
Chloasma is not harmful or contagious, but it can be emotionally distressing and cosmetically concerning. Understanding its causes, signs, and available treatments can help manage and prevent the condition effectively.
What Is Chloasma (Melasma)?
The term Chloasma comes from the Greek word chloazein, meaning “to be greenish,” though the patches are usually brown or gray-brown. It occurs due to an increase in melanin production, the pigment responsible for skin color, in certain areas of the skin.
When melanocytes (melanin-producing cells) become overactive—often triggered by hormones or sun exposure—they produce excess pigment, leading to hyperpigmentation.
Chloasma is commonly seen in:
Pregnant women (hence the term mask of pregnancy).
Women on oral contraceptives or hormone replacement therapy.
People with darker skin tones (Fitzpatrick skin types III–V).
Individuals exposed to frequent sunlight or heat.
Types of Chloasma
Chloasma is categorized based on the depth of pigmentation in the skin:
1. Epidermal Chloasma
Pigment is present in the outer layer of skin (epidermis).
Patches appear dark brown with well-defined borders.
More responsive to topical treatments.
2. Dermal Chloasma
Pigment lies deeper in the dermis.
Patches appear light brown or bluish-gray with blurred edges.
Harder to treat and may persist longer.
3. Mixed Type Chloasma
Combination of epidermal and dermal pigmentation.
Most commonly seen in clinical practice.
Causes of Chloasma
The exact cause of Chloasma is not fully understood, but it results from melanocyte hyperactivity triggered by multiple factors. Below are the most common causes and risk factors:
1. Hormonal Changes
Increased levels of estrogen and progesterone stimulate melanocytes.
Common during pregnancy, menopause, or when using birth control pills.
Also seen in women undergoing hormone replacement therapy.
2. Sun Exposure
Ultraviolet (UV) rays activate melanocytes, leading to melanin overproduction.
Sun exposure worsens existing patches and can trigger recurrence.
3. Genetic Predisposition
Family history increases susceptibility.
Genetic factors determine skin sensitivity to hormones and sunlight.
4. Cosmetic or Skin Irritation
Certain cosmetics or harsh skin-care products may irritate the skin and cause pigmentation.
5. Medications
Some antiseizure drugs and photosensitizing medications can trigger melasma-like pigmentation.
6. Thyroid Disorders
Hypothyroidism and other thyroid imbalances are linked with higher risk of chloasma.
7. Stress
Chronic stress can increase cortisol levels, indirectly affecting hormone balance and pigmentation.
Signs and Symptoms of Chloasma
Chloasma primarily affects sun-exposed areas of the face, though it can sometimes appear on the neck and forearms. The condition presents as flat, discolored patches.
Common Symptoms Include:
Brown, gray-brown, or bluish patches on:
Cheeks
Forehead
Bridge of the nose
Upper lip
Chin
Symmetrical appearance on both sides of the face
Gradual development (not sudden)
No pain, itching, or scaling
Key Characteristics:
Symmetry: Patches often appear evenly on both sides of the face.
No texture change: Unlike rashes, the skin remains smooth.
Sensitive to sunlight: Exposure to sunlight intensifies pigmentation.
Diagnosis of Chloasma
Diagnosis is primarily clinical, based on appearance and patient history, but dermatologists may perform additional tests to confirm and classify the condition.
1. Visual Examination
The dermatologist observes the pattern, color, and distribution of pigmentation.
2. Wood’s Lamp Examination
A special ultraviolet light is used to determine the depth of pigmentation.
Helps classify Chloasma as epidermal, dermal, or mixed.
3. Dermatoscopy
A magnified visual tool helps analyze skin patterns and pigmentation distribution.
4. Skin Biopsy (Rare)
Conducted only if the diagnosis is uncertain or to rule out other pigmentary disorders.
Prevention of Chloasma
Since Chloasma is a chronic and relapsing condition, prevention focuses on sun protection and hormonal management. Below are practical preventive measures:
1. Avoid Sun Exposure
Limit time outdoors, especially between 10 AM to 4 PM.
Seek shade when possible.
2. Use Sunscreen Daily
Apply broad-spectrum sunscreen (SPF 30 or higher) daily, even indoors.
Reapply every 2–3 hours when outdoors.
3. Wear Protective Clothing
Use wide-brimmed hats, sunglasses, and UV-protective clothing.
4. Avoid Triggers
Limit use of oral contraceptives or hormonal medications if possible.
Avoid skin-irritating products or strong cosmetics.
5. Follow a Gentle Skincare Routine
Use fragrance-free cleansers and moisturizers.
Avoid frequent exfoliation that may worsen pigmentation.
6. Manage Stress and Hormones
Practice stress-reducing techniques such as yoga, meditation, and balanced sleep.
Treatment of Chloasma
While Chloasma may fade over time—especially after pregnancy or discontinuing hormonal therapy—many individuals require medical treatment to reduce pigmentation.
Treatment should always be guided by a dermatologist, based on the type and severity of Chloasma.
1. Topical Treatments
a. Hydroquinone
The gold standard depigmenting agent.
Works by inhibiting melanin production.
Used as a 2–4% cream, applied once daily at night.
Should not be used long-term due to risk of irritation or ochronosis.
b. Tretinoin (Retinoic Acid)
Stimulates skin cell turnover.
Enhances the penetration of other lightening agents.
Often used in combination with hydroquinone.
c. Corticosteroids
Reduce inflammation that contributes to pigmentation.
Used in triple combination creams (Hydroquinone + Tretinoin + Corticosteroid).
d. Azelaic Acid
Natural alternative to hydroquinone.
Safe for pregnant women.
e. Kojic Acid and Arbutin
Plant-derived skin-lightening agents that inhibit melanin formation.
2. Oral Treatments
a. Tranexamic Acid
Reduces melanocyte activation.
Given orally or as topical/transdermal formulations.
Must be prescribed by a dermatologist due to potential side effects.
3. Procedures and Advanced Treatments
a. Chemical Peels
Use glycolic acid, lactic acid, or salicylic acid to exfoliate the upper skin layer.
Helps fade superficial pigmentation.
b. Laser Therapy
Fractional lasers and Q-switched Nd:YAG lasers target melanin.
Effective but requires professional handling to avoid rebound pigmentation.
c. Microneedling
Stimulates collagen and enhances absorption of topical agents.
d. Intense Pulsed Light (IPL) Therapy
Targets pigmented areas with light pulses.
Best suited for resistant cases.
4. Home Remedies (Supportive Only)
While not a substitute for medical treatment, natural remedies may help lighten mild pigmentation:
Aloe Vera Gel – Contains aloesin that reduces melanin synthesis.
Lemon Juice (diluted) – Acts as a mild natural bleach (use cautiously).
Turmeric Mask – Has antioxidant and anti-inflammatory properties.
Green Tea Extracts – May help reduce pigmentation and inflammation.
(Always do a patch test before trying home remedies.)
Prognosis of Chloasma
Chloasma is benign but chronic and relapsing.
In many women, melasma fades post-pregnancy or after discontinuing hormonal drugs.
However, recurrence is common, especially without proper sun protection.
Consistent skincare and medical follow-up are crucial for long-term control.
FAQs on Chloasma
1. What is the difference between Chloasma and Melasma?
There is no difference—both terms refer to the same condition. “Chloasma” is an older term, while “Melasma” is more widely used in dermatology.
2. Can men get Chloasma?
Yes, although less common. Men exposed to excessive sunlight or using photosensitizing drugs may develop Chloasma.
3. Is Chloasma dangerous or cancerous?
No. Chloasma is a harmless pigmentation disorder and does not lead to cancer.
4. Does Chloasma go away after pregnancy?
In many women, Chloasma fades gradually after delivery when hormone levels normalize.
5. Can sunscreen alone treat Chloasma?
Sunscreen does not cure Chloasma but is essential to prevent worsening and recurrence.
6. Can diet affect Chloasma?
While no direct food causes Chloasma, a balanced diet rich in antioxidants (vitamin C, E, and zinc) supports skin repair.
7. Is laser treatment safe for Chloasma?
Yes, if performed by experienced dermatologists. Improper use may worsen pigmentation.
8. Can Chloasma return after treatment?
Yes. Chloasma often recurs, especially with continued sun exposure or hormonal triggers.
9. Is there a permanent cure for Chloasma?
No permanent cure exists, but effective management and prevention can significantly reduce pigmentation.
10. Can stress cause Chloasma?
Chronic stress affects hormonal balance, which may indirectly contribute to melasma development.
Conclusion
Chloasma (Melasma) is a common, harmless, but psychologically distressing skin condition that primarily affects women. It arises due to hormonal influences, sun exposure, and genetic predisposition, resulting in dark patches on the face.
Effective management involves sun protection, topical treatments, lifestyle modification, and, in some cases, advanced dermatological procedures. Early diagnosis and consistent preventive measures can control Chloasma and restore a clearer, even skin tone.