Effects of Hyperpigmentation in Indians

Hyperpigmentation is a skin condition in which patches of skin become darker in colour than the normal surrounding skin. This darkening occurs when an excess of melanin deposits in the skin.    

What is Cholasma?   

Cholasma is also referred to as the mask of pregnancy. It is a required hypermelanosis of sun-exposed areas occurring during pregnancy which usually affects women. Cholasma presents as symmetric hyperpigmented macules, which can confluent or punctuate. The most common locations are the cheeks, the upper lip, the chin and the forehead. In cholasma skin on the face become darker which generally appear as irregular, blotchy shaped patches that range in colour.

How to identify pigmentation? 

To identify pigmentation whether it is epidermal, dermal or mixed it can be done using woods lamp in woods lamp epidermal cholasma or melasma all areas are intensified whereas in case of dermal it is not intensified & in mixed type it is little intensified. In case of pigmentation type superficial epidermal is light form of pigmentation whereas for deeper pigmentation it is much more blackish & for mixed type it is combination of blackish & light brown colour. These could be centrofacial, mandibular or forehead & the morphology is continuous these types are very difficult to treat. Epidermal type is easy to treat but in case of dermal & mixed treatment is very difficult.

Issued in Public Interest by Oaknet Healthcare

What are the etiopathologies of Cholasma?  

Cholasma can be idiopathic which means no cause can be found  

• Hormonal Changes - These changes in pigmentation are triggered by an increase in estrogen that stimulates the production of melanin. Women taking oral contraceptives or hormone replacement therapy (HRT) also experience chloasma due to hormonal changes.

Effect of the increased estrogen is magnified by the higher levels of progesterone that pregnancy triggers as well. This is also what often causes the linea nigra or the dark line down the center of belly during pregnancy.  

• Sun – Exposure to sun also leads to chloasma. The ultraviolet (UV) light from the sun encourages melanocytes to produce melanin, which can be a trigger for development and can also exacerbate existing chloasma.
• Family History - According to the AAD, people of colour are more likely than those with lighter skin to develop chloasma because their melanocytes are more active. Those with blood relatives who have had chloasma are also more likely to develop it.  
• Medications and scented products — new targeted therapies for cancer and perfumed soaps, toiletries, and cosmetics may cause a phototoxic reaction to trigger melasma  

What are treatments for cholasama? 

The treatment options for Cholasma include Topical Treatments, Chemical Peels, & Laser Treatment  

Topical Treatment  

• Hydroquinone – Hydroquinone is most commonly used. The mechanism of action is inhibition of tyrosinase, leading to the decreased production of melanin. Hydroquinone can be applied in cream form or as an alcohol-based solution.  
• Tretinoin – Tretinoin is less effective than Hydroquinone. However, the response to treatment is less than with hydroquinone and can be slow, with improvement taking 6 months or longer. The retinoid is believed to work by increasing keratinocyte turnover and thus limiting the transfer of melanosomes to keratinocytes. 
• Arbutin & Kojic acid can be used alone or in combination for the treatment of cholasma  
• Azelaic acid

Chemical Peels

• Chemical peels containing glycolic acid or trichloroacetic acid.

• Tretinoin alone is used as a peel.

Laser treatment

A number of types of laser therapy have been used including:

• Fractional lasers
• Q-switched Nd:YAG lasers
• Intense pulsed light

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