Melasma (Chloasma)
What Is Melasma?
Melasma is a skin condition characterized by darker patches of skin, known as hyperpigmentation. These patches most commonly appear on the face, especially the forehead, cheeks, and upper lip. The patches are usually symmetrical and can range from light tan to dark brown. Although rare, melasma can also develop on other sun-exposed areas of the body.
Melasma is more prevalent in women than men and is often linked to hormonal fluctuations. For this reason, it frequently occurs during pregnancy or when taking hormonal medications such as birth control pills or hormone replacement therapy (HRT). Melasma during pregnancy is so common that it is sometimes referred to as "the mask of pregnancy" or "chloasma." The dark patches often lighten or disappear after pregnancy ends.
Exposure to sunlight is the most significant factor contributing to the development of melasma. Medications that increase sensitivity to sunlight (photosensitizers) can also increase the risk of melasma. These include certain antibiotics and diabetes medications, as well as some cosmetics. Protecting your skin from the sun is a critical part of managing melasma, and people who avoid sun exposure are less likely to experience this condition.
Symptoms
The primary symptom of melasma is the appearance of dark patches on the skin, typically on the forehead, cheeks, chin, temples, and above the upper lip. These patches are strictly cosmetic; they do not cause pain or discomfort. The patches are usually symmetrical, meaning they look similar on both sides of the face.
Diagnosis
Doctors can usually diagnose melasma by visually examining the affected skin. Your medical history will help determine any contributing factors. In some cases, a healthcare provider may use a special lamp emitting ultraviolet light to better assess the depth and pattern of the pigmentation. Lab tests are usually not performed.
Duration
In many cases, the dark patches of melasma will fade once the underlying cause—such as pregnancy or hormonal medication—has been addressed. The discoloration can take several months to gradually disappear, though in some instances, it may not fully resolve. For some people, melasma lasts for many years or a lifetime.
Prevention
The best way to prevent melasma is to limit your skin's exposure to sunlight. Preventive measures include:
- Wearing a wide-brimmed hat to shield your face.
- Applying sunblock containing zinc oxide or titanium dioxide to protect vulnerable areas.
- Using sunscreen with broad-spectrum protection against both UVA and UVB rays and an SPF of at least 30.
- Limit sun exposure, especially during peak hours of the sun (between 10 a.m. and 2 p.m.).
While not always possible, it’s also best to avoid hormonal medications such as birth control pills and hormone replacement therapy.
Treatment
As hormonal levels stabilize, melasma usually begins to fade. Women who develop melasma during pregnancy often notice the dark patches fading several months after giving birth. Similarly, women taking oral contraceptives or hormone replacement therapy may see improvement once they stop the medications.
Several treatments are available to help reduce or eliminate melasma patches:
- Hydroquinone: A topical cream that reduces pigment production, helping to lighten the skin.
- Tretinoin: A vitamin A derivative that accelerates skin cell turnover, helping to shed pigmented cells more quickly.
- Azelaic acid: This cream helps inhibit melanin production, which can prevent further darkening of the skin.
- Chemical peels: These involve applying a solution to the skin that causes a mild chemical burn, promoting the peeling of the outer skin layers to reveal new skin. Glycolic acid is a common ingredient in mild peels with a lower risk of scarring or discoloration.
- Intense Pulsed Light (IPL) therapy: A non-invasive treatment that uses specific wavelengths of light to target and break down pigmented areas of skin.
Treatment options
The following list of medications are related to or used in the treatment of this condition.
When to Seek Medical Advice
While melasma does not require treatment, you should consult a doctor if you notice any unexplained skin discoloration. A healthcare provider can help distinguish melasma from other skin conditions that may need medical attention.
Prognosis
Melasma is not harmful, and much of the discoloration may resolve on its own once hormone levels stabilize and sun exposure is reduced. For persistent or bothersome patches, treatments can help lighten the skin, and cosmetics can be used to even out skin tone.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.