In 2023, author and former Bollywood actor Twinkle Khanna shared a personal health experience that resonated with countless women across India. The 52-year-old revealed she developed melasma, a common skin pigmentation disorder, during her second pregnancy. She humorously described the condition as an "uninvited guest" or "bin bulaya mehman" that arrived after a family trip, leaving her with a flare-up instead of souvenirs.
What Exactly is Melasma?
Melasma is a dermatological condition characterized by dark, discolored patches on the skin, most frequently appearing on the face. Medically referred to as chloasma, it commonly surfaces during pregnancy but can also affect women using birth control pills or hormone therapy, and even men. The patches are typically brown or gray-brown in color and appear on the cheeks, forehead, bridge of the nose, upper lip, and chin.
While the condition is not painful, itchy, contagious, or cancerous, its visible nature often impacts self-confidence and emotional well-being, as individuals may feel embarrassed by the changes in their appearance.
Triggers and Causes of Skin Discoloration
The root cause of melasma lies in the overactivity of melanocytes, the cells that produce skin pigment (melanin). This leads to excessive melanin production. Although the exact mechanism isn't always clear, several key triggers are well-established:
- Sun Exposure: Ultraviolet (UV) rays are the primary catalyst, worsening existing melasma and causing relapses after treatment.
- Hormonal Changes: Fluctuations during pregnancy, from birth control pills, or due to hormone replacement therapy are major contributors.
- Genetics: A family history of melasma increases an individual's risk.
- Skin Sensitivity: Certain medications and skincare products can make skin more prone to pigmentation.
- Other Factors: Stress and thyroid disorders may also play a role for some people.
The condition is notably more prevalent in women, particularly those with medium to dark skin tones (Fitzpatrick types III–V).
Treatment Pathways and Twinkle's Advice
Melasma is notoriously stubborn and prone to recurrence, making consistent management crucial. Twinkle Khanna, in her candid discussion, joked about now advising every pregnant woman she meets to use tranexamic acid, niacinamide, and sunscreen. Her openness has helped destigmatize the condition, emphasizing that while it is harmless physically, it requires proper medical attention for the emotional challenges it poses.
Common treatment strategies include:
- Topical Creams: First-line treatments like hydroquinone, triple-combination creams (hydroquinone, steroid, retinoid), niacinamide, kojic acid, and vitamin C.
- Oral Medication: Tranexamic acid (oTA), as mentioned by Khanna, is an effective oral treatment for cases resistant to topical creams, but must be taken under strict medical supervision due to potential effects on blood clotting.
- Dermatological Procedures: Chemical peels, microneedling, and laser therapies (used cautiously, especially on darker skin tones to avoid irritation).
The Non-Negotiable: Sun Protection
Khanna's emphasis on sunscreen is backed by dermatologists worldwide. Sun protection is the single most critical step in managing and preventing melasma. UV rays activate melanocytes, and exposure can happen even through windows or on cloudy days. Experts recommend daily use of a broad-spectrum sunscreen with SPF 30 or higher, reapplied every 2-3 hours when outdoors, combined with wide-brimmed hats, sunglasses, and seeking shade during peak sun hours (10 a.m. to 4 p.m.).
Beyond Creams: The Emotional and Lifestyle Aspect
Twinkle Khanna also highlighted an important message about self-care, especially for new mothers. She stated, "Everyone expects us to be Mother India and focus all our energies on the child. Let me tell you — the child will grow up, go to college, and you will still be living with melasma. So give yourself permission to take care of yourself and your skin." This resonates with women who often neglect their own well-being.
Effective management also involves patience, as results take weeks or months, avoiding harsh scrubs, managing stress, ensuring proper sleep, and most importantly, consulting a dermatologist for a personalized plan instead of experimenting with potent products.
When to See a Doctor: While melasma isn't dangerous, consult a dermatologist if dark patches appear suddenly or change, or if over-the-counter products provide no relief after several months. A specialist can confirm the diagnosis, rule out other disorders, and create a safe, monitored treatment protocol.
