Melasma: Symptoms, Causes, and Treatment

Melasma is a common skin pigmentation issue that causes dark, blotchy, and uneven skin tone on sun-exposed areas, chiefly on the face. Melasma symptoms are more common in women than in men and generally appear for the first time during reproductive age or pregnancy.

Although it's medically harmless, for many people the discoloration is a cause of embarrassment so it is common to seek treatment. Melasma is also called chloasma or the mask of pregnancy.

This article discusses melasma symptoms, causes and risk factors, and potential treatment options for this skin condition.

Symptoms

Dark Patches on Face

Melasma causes hyperpigmentation or discolored marks that are darker than your surrounding skin. The skin looks blotchy and uneven, with irregular borders on the discolored spots.

Appears on Sun-Exposed Skin

Melasma develops on sun-exposed areas of the skin, most often the face. Above the upper lip, across the cheeks, nose, and forehead are all very common areas to find it, but melasma can develop anywhere on the face. It also can develop on the chest, upper arms, and upper back, though not as frequently.

Symmetrical

The key factor with melasma is that it typically appears symmetrically on the face. You'll notice "matching" patches on both cheeks, or spots that have developed evenly across the nose or the forehead.

May Cover a Large Area

Patches of melasma can join together, forming one or more larger areas of hyperpigmentation.

Color and Darkness Can Vary

The discoloration can range from slightly darker than your normal skin color to extremely dark. Depending on your skin tone and the severity of your melasma, the discoloration can be light brown to nearly black.

In persons with darker skin tones, melasma can appear bluish-gray in color.

Painless

These areas of discoloration don't hurt, burn, or itch. In fact, you won't notice anything different about these areas of skin aside from the fact they're discolored.

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Causes

Melasma develops when there is excess melanin in certain areas of the skin. Melanin is the substance that gives your skin, eyes, and hair their color. People with dark complexions have skin that produces more melanin; those with lighter complexions have less melanin.

Melanocytes are cells in your skin that create melanin. For reasons that aren't clear, these cells sometimes malfunction and start making more melanin in certain areas than in others. The excess melanin produces the dark, blotchy areas we know as melasma.

With melasma, the discoloration is limited to the epidermis, which is the outermost layer of the skin. However, research suggests that the deeper layers of the skin (the dermis) may also play a role in melasma development.

Risk Factors

There are certain risk factors that make you more susceptible to developing melasma. The more of these factors you have, the more likely you are to develop melasma. But, in some cases, melasma develops without any apparent risk factor.

Complexion

If your complexion is olive, medium, to medium-dark toned, and you tan very easily, you have a higher chance of developing melasma than those with very light or very dark complexions. People who are most likely to develop melasma are those whose skin falls between a III and V on the Fitzpatrick scale (a way of measuring skin tone, with I being the lightest complexions and VI being the darkest complexions). It isn't as common in skin types that fall on the far ends of the spectrum.

Hormones

Melasma development is linked to increased estrogen hormones. This explains why melasma is much more common in women than it is in men. Men can develop it, though, especially if there is a strong family history.

Since thyroid problems affect the hormones, you also have a higher chance of developing melasma if you have thyroid issues.

Pregnancy

There's a reason why melasma is also called the "mask of pregnancy." Pregnant persons often develop this condition. Increased levels of estrogen and progesterone during pregnancy are thought to trigger melasma in some people.

Sun Exposure

Another huge trigger factor in melasma development is excessive sun exposure. In fact, you may notice your melasma looks more obvious during the sunnier summer months and fades a bit during the winter. The sun's ultraviolet rays stimulate the melanocytes to create more melanin.

Genetics

A person may be genetically predisposed to developing melasma. An overwhelming number of people with melasma also have relatives with the problem. So, if you have a strong family history, you should do your best to limit other triggers when possible.

Certain Drugs and Cosmetic Products

Certain medications may raise your risk of developing melasma. The list includes:

• Birth control pills
• Hormone replacement therapy
• Anti-seizure medications
• Tetracyclines

Also, any cosmetic products that make your skin more sensitive to the sun may increase your risk. However, none of these are considered primary risk factors.

Diagnosis

Melasma diagnosis is done by a simple visual inspection by your healthcare provider. They may also take a look at your skin under a Wood's lamp (a type of black light) to better see pigmentation and sun damage on the surface of the skin, as well as damage that is deeper and not yet visible to the naked eye.

Very rarely, your healthcare provider may do a biopsy of the affected area to confirm it is melasma. This is only done if there's a question it may be another skin problem.

Other Conditions That Cause Skin Discoloration

There are many skin conditions that cause hyperpigmentation. Most are fairly easy to differentiate from melasma, but some can look very similar, especially if you aren't familiar with them.

Age Spots

Often called liver spots, age spots, or sun spots, the technical term for this type of hyperpigmentation is solar lentigines. Solar lentigines are round, oval, sometimes irregularly shaped, dark marks.

Like melasma, solar lentigines are flat areas of discoloration that develop over sun-exposed areas of skin. The difference is that melasma generally covers a larger area and develops symmetrically on the face. Solar lentigines are more common in fair complexions.

Post-Inflammatory Hyperpigmentation

The key difference between post-inflammatory hyperpigmentation and melasma is the cause. Post-inflammatory hyperpigmentation develops after some sort of inflammatory wound: a cut, scrape, burn, eczema patch, or inflammatory acne. It's not a scar, but rather a flat area of discolored skin left behind after the skin heals.

Freckles

Ephelides, more commonly known as freckles, can develop because of sun exposure. They look like they're "sprinkled" across the skin, rather than in large patches. Certain skin types are more prone to them.

Treatment

Melasma isn't a harmful or contagious condition; it's completely cosmetic. If it's not bothering you, there is no medical reason to treat it.

In some cases, the discoloration may fade over time. This is most likely to happen if the melasma appeared during pregnancy.

Melasma is often a chronic condition, making it difficult to treat. Multiple factors like sun exposure, hormones, and skin type may contribute to the problem.

Topical products can keep discoloration in check, but if you stop using them, the discoloration resurfaces. Be prepared to use some type of treatment long-term.

If you do choose to treat it, you have several options. Your dermatologist will help you devise the best long-term treatment plan for your skin.

Prescription Topical Medications

Topical prescription medications are the mainstay of melasma treatment. Depending on what your healthcare provider decides is best for you, you may be prescribed:

• Hydroquinone (sometimes combined with kojic acid)
• Topical corticosteroids
• Tretinoin
• Azelaic acid

Over-the-Counter Products

Although over-the-counter products aren't the most effective options for treating melasma, they may help fade hyperpigmentation over time especially if the discoloration is rather minor. They also can be used as maintenance once you've achieved good results with other treatments. These include:

• Glycolic acid
• Licorice extract
• Vitamin C (L-ascorbic acid)

Procedural Treatments

In some cases, in-office procedures may be used to treat melasma. These are often used alongside other topical treatments. They include:

• Microdermabrasion
• Chemical peels
• Laser treatments

Prevention

Whatever treatment option you choose, there is one key step that you mustn't skip: sun protection. The sun is a huge factor when it comes to melasma development. No treatment will work well if you're not also protecting your skin from the sun.

Sun Protection

Sun protection can't end when your melasma treatment does. Once you're happy with the results, you still must be diligent in your sun protection routine. Even a few hours of unprotected sun exposure can cause melasma to come back more severely.

Apply sunscreen of 30 SPF or higher daily. You should apply sunscreen every day as part of your skincare routine, even when it's cloudy or you're only spending limited time outdoors.

It goes without saying you shouldn't tan, either in the sun or in a tanning bed, if you're trying to improve melasma. And don't want to sunbathe while you're pregnant since you're more susceptible to developing melasma during pregnancy.

Coping

Melasma may be a mere annoyance without really bothering you. Or, you may be incredibly self-conscious or embarrassed by your melasma.

Here are a few tips to help you when you're feeling discouraged or self-conscious.

• Use your treatments exactly as prescribed. Consistent treatment is key to getting the best results. If you aren't sure, ask your healthcare provider for clarification.
• Give treatments enough time to work. Melasma fades slowly, over a long period of time. You won't see results immediately. Try to be patient and expect treatment to last several months minimum.
• Always protect your skin from the sun. This is especially important when treating melasma. Use sunscreen and wear protective clothing such as a hat.
• Don't scrub. It may seem counterintuitive, but scrubbing at the skin isn't recommended. Scrubbing won't fade the discolorations and can actually make them worse by irritating the skin and causing inflammation.
• Try corrective makeup. Regular foundation or concealer can blend the discolorations and make them less obvious. If you want complete coverage, try camouflage makeup or corrective makeup. This type of product is specially formulated to completely cover all sorts of skin imperfections, from scars, vitiligo, tattoos, birthmarks, and melasma.

Summary

Melasma is a harmless skin condition that causes dark patches and spots, usually on the face. It is commonly triggered by hormones (such as during pregnancy) and sun exposure. For some people, the condition may go away on its own. For others, it often requires long-term treatment, which typically involves consistent sun protection and topical medication to lighten the skin.