Melasma

What it is

Melasma is a chronic condition in which brownish patches with irregular, usually symmetrical borders appear on the areas of the face most exposed to the sun: forehead, cheeks, upper lip and nose. It mainly affects women, especially during pregnancy, with the use of hormonal contraceptives, and in darker skin tones, and tends to worsen with sun, heat and visible light. There is no definitive cure, but it can be very well controlled. At Femi Saúde, Dr. Ana Kappes assesses the depth of the patches, identifies the factors that make them worse, and puts together a long-term plan that combines rigorous sun protection, topical lightening agents and procedures such as peels and laser, always taking care to avoid rebound darkening.

Most common symptoms

• Brownish patches on the cheeks and forehead
• Symmetrical patches on the upper lip and nose
• Irregular borders, without flaking
• Worsening after sun or heat exposure
• Darkening during pregnancy
• No pain, itching or raised texture

Causes and risk factors

• Exposure to sunlight and visible light
• Hormonal changes of pregnancy
• Use of hormonal contraceptives
• Genetic predisposition and darker skin tone
• Intense heat and skin inflammation

How it is diagnosed

The diagnosis of melasma is clinical, based on the appearance and typical distribution of the patches. The dermatologist uses Wood's lamp or dermoscopy to estimate whether the pigment lies mainly in the epidermis, the dermis, or both, which helps predict the response to treatment. The consultation also investigates factors that worsen it, such as hormone use, pregnancy, sun exposure habits and irritating cosmetics. When a patch has unusual features, it may be necessary to distinguish it from other conditions, such as post-inflammatory hyperpigmentation, and a biopsy is rarely needed.

How we treat it at Femi Saúde

Controlling melasma starts with daily sun protection using a broad-spectrum, tinted sunscreen, a hat, and reduced exposure to sun and heat. Topical lightening agents with hydroquinone, tranexamic acid, azelaic acid, retinoids or combinations form the basis of treatment, adjusted in cycles to avoid irritating the skin. Superficial chemical peels, microneedling and lasers with gentle settings can speed up results in selected cases. When indicated, oral tranexamic acid is an option. Throughout treatment, the dermatology team at Femi Saúde monitors the skin's response and tolerance and reinforces maintenance, which is essential to prevent the patches from returning.

What we offer