what causes cloasma?

Question

patches of brown stuff on your cheeks, forehead etc

Answer 1

Chloasma is usually caused by pregnancy or oral contraceptives; probably due to sunlight.

Answer 2

1

Answer 3

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Answer 4

Chloasma usually affects women but occasionally is seen in young men who use after-shave lotions, scented soaps, and other toiletries.

Chloasma is especially common in women aged 20-40. It affects the forehead, cheeks and upper lips. It occurs frequently during pregnancy and is more common in dark skins than in fair skins. Often called "the mask of pregnancy", chloasma is more pronounced during the summer months as a result of sun exposure. It usually fades a few months after delivery. Repeated pregnancies, however, can intensify the pigmentation.

Chloasma also occurs as a side-effect of taking contraceptive pills and injected depot contraceptive preparations. It may also be noticed in apparently healthy, normal, non-pregnant women where it is presumed to be due to some mild and harmless hormonal imbalance.

Sun exposure, following the use of deodorant soaps, scented toiletries, and various cosmetics can also produce this mottled pigmentation. This is called a phototoxic reaction and is due to ultraviolet radiation being absorbed by the chemical substance (perfume, cologne and other types of fragrance) on the skin. This pigmentation often extends down to the sun-exposed areas of the neck and may be more pronounced on the right side of the forehead, face and neck due to sun exposure while driving a car (or the left side - if you drive on the right).

Treatment
Discontinue birth control pill
If you are on hormonal contraception, consider stopping this. However any benefit from changing hormonal preparations is usually slow to become apparent.

Sun protection
It is very important to minimise sun exposure on the face. Use a broad-spectrum very high protection factor sunscreen of reflectant type and apply it to the whole face. Alternatively, use a make-up with a sunscreen in it.

Avoid irritating the facial skin
No strong soaps or abrasive cleaners - use only a mild soap or cleanser for washing.

Bleaching creams
Bleaching creams contain hydroquinone, which inhibits formation of new pigment. Bleaching creams take 3 to 6 months to obtain a worthwhile lightening of pigmentation. Even then, just a "whiff" of summer sun can darken the pigment again and spoil months of hard work. Follow the instructions in the packet insert carefully. Apply a small amount of cream daily to a small test area of chloasma on the side of the face then, if there is no redness, itching or scaling, after, say, 5 days, apply the cream twice a day to the area. If still well tolerated, apply the cream accurately to all the pigmented areas twice a day. Avoid applying bleaching cream to normal skin as this will lighten as well. When using a sun screen, apply the bleaching cream first then the sunscreen on top. Stop daily bleaching cream after six months or so, or at least reduce to twice weekly applications.

Topical alpha hydroxyacids
A face cream containing a fruit acid or alpha hydoxyacid (glycolic acid, lactic acid, Kojic acid).

Tretinoin cream
If progress is slow using a hydroquinone cream alone, tretinoin cream (a prescription medicine) may be used. Tretinoin always causes a degree of pinkness and peeling of the facial skin which can be controlled by starting with a little then building up. It may fade freckles, improve acne and smooth wrinkles. A sun screen must be applied as well. Tretinoin should not be used in pregnancy.

Azelaic acid cream
Azelaic acid inhibits formation of pigment and is also effective against acne. Try it first on a small test area of the chloasma as described above for bleaching creams. There can be mild stinging after putting it on, followed by a little peeling. This will settle with continued use of the cream. As with the bleaching creams, it takes several months to see worthwhile lightening of the pigment.

Superficial peels
Repeated superficial chemical peels (glycolic acid or Jessner solution) may be helpful. Deeper chemical peels run the risk of increasing pigmentation and causing uneven results, but may be recommended in severe cases.

Laser peel
Laser resurfacing is sometimes worthwhile but should be performed cautiously as it can aggravate pigmentation. It is very important to follow up with careful sun avoidance and it may also be necessary to use hydroquinone.

Make-up
Cosmetic camouflage
Another approach to chloasma is to use special camouflage cosmetics.

Results take time and the above measures are rarely completely successful.

Related information
Other websites:
Melasma – emedicine dermatology, the online textbook
Books:
See the DermNet NZ bookstore
DermNet does not provide an on-line consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.

Answer 5

Check out this site http://www.umm.edu/ency/article/000836.htm

Answer 6

chloasma/melasma same thing, ususally due to hormones and/or sun exposure.