What is Melasma? Causes, Symptoms & Treatments
Melasma is a skin condition that causes darkened, brown patches of skin to develop on your face. It’s a common condition that affects people of all ages, from young children and teens to adults and the elderly.
About five million Americans are affected by melasma, making it one of the most common skin conditions. As well as “melasma,” it’s occasionally referred to as “chloasma” and the “mask of pregnancy.”
Unlike most skin conditions, which affect men and women equally, melasma tends to be much more common in women than it is in men. According to the American Academy of Dermatology, as much as 90% of all people affected by melasma are female.
If you have melasma, you’ve probably noticed blotchy, brown patches of skin on your forehead, cheeks and other parts of your face.
Although the symptoms can look similar, melasma is different from other skin conditions such as hyperpigmentation. Because these conditions look similar, it’s quite common for people affected by melasma to assume they have sun or psoriasis-related hyperpigmentation.
Luckily, melasma doesn’t need to be something you’ll have to deal with forever. Using a variety of treatment options, it’s usually possible to bring melasma under control and keep your facial skin clear, consistent and free of hyperpigmentation.
Concerned you might have melasma? Below, we’ve covered everything you need to know about this common skin condition, from causes and symptoms to treatment options, as well as the key differences between melasma and other common skin hyperpigmentation conditions.
What is Melasma?
Melasma is a pigmentary condition that can cause your skin to become blotchy and darkened in certain areas. It usually affects the skin on your face, although it can and does affect other parts of the body.
The most common sign of melasma is the development of darkened, blotchy areas of skin near your forehead, cheeks, nose and lips.
When melasma starts to affect your skin, it’s rarely sudden. Usually, dark, hyperpigmented skin develops slowly over several weeks or months, leaving you with darkened patches of skin that aren’t obvious at first but quickly become visible as time goes on.
While skin hyperpigmentation can occur in men and women, melasma is particularly common in women. Scientists believe that melasma is likely caused by increases in your body’s production of certain hormones -- a key reason it affects women more frequently than men.
Skin discoloration caused by melasma isn’t harmful, meaning there’s no need to worry about it affecting your overall health. However, it can make you feel less confident about your skin and general appearance, especially when it occurs in obvious, highly visible areas of your face.
What Causes Melasma?
Right now, researchers aren’t completely sure what causes melasma. The strongest potential cause appears to be spikes in your body’s production of hormones such as progesterone and estrogen, both of which are more prevalent in women than in men.
Your estrogen and progesterone levels can vary over time. Even over a fairly short period of time like your menstrual cycle, your body’s production of estrogen, progesterone and other essential hormones can fluctuate dramatically.
This is one reason why acne and other hormonal skin conditions are particularly common as you approach your period, a topic we’ve covered in our guide to hormonal acne.
However, estrogen and progesterone aren’t the only factors scientists believe are involved in melasma. Today, researchers believe melasma is caused by a combination of factors ranging from hormonal fluctuations to genetics and UV exposure.
From a genetic perspective, melasma tends to affect people with darker skin tones more than people with lighter skin tones. About 40 percent of Southeast Asian women have some degree of melasma, and melasma levels are also high in Hispanic and Central Asian populations.
Despite this, people of every ethnic background can potentially suffer from melasma. Melasma also tends to run in families, with both women and men having the potential to inherit and pass melasma on to their children.
From a UV exposure perspective, researchers currently believe that exposure to sunlight can and often does affect melasma. Currently, experts in melasma think that this is because of the effects of sun exposure on melanogenesis -- the body’s process of creating melanin pigments.
In short, there’s no single cause of melasma. Instead, a variety of factors, from your genetics to your level of sun exposure and your body’s production of hormones, could all play different roles in causing melasma to develop.
Pregnancy and Melasma
Melasma is particularly common during pregnancy. In fact, all forms of skin hyperpigmentation are more common during pregnancy, with the vast majority of women experiencing some level of hyperpigmentation and discoloration while pregnant.
During pregnancy, about 10 to 15 percent of women can expect to experience some degree of melasma.
While researchers aren’t completely sure why melasma is more common during pregnancy, the most likely culprit is an increase in your body’s production of hormones such as progesterone and α-Melanocyte-stimulating hormone (α-MSH), both of which can affect skin pigmentation.
Birth Control and Melasma
Another factor that can increase your chance of developing melasma is your use of hormonal birth control.
If you use a combined oral contraceptive pill that’s made up of estrogen and a progestin, the pill’s effect on your hormones could make you more susceptible to melasma and other skin hyperpigmentation conditions.
This happens because melasma-prone skin is more responsive to estrogen than non-melasma skin. Since oral contraceptives elevate your levels of estrogen and progesterone, they can also stimulate melasma skin, increasing your risk of experiencing pigmentation issues.
Annoyingly, studies show that switching to a progestin-only birth control pill usually isn’t effective at stopping melasma. If your melasma is caused by birth control, the most effective way to bring it under your control is to stop using hormonal birth control and switch to another contraceptive.
Obviously this is something you’ll want to talk to your doctor about, as birth control can affect a variety of factors related to your skin health.
Melasma vs. Hyperpigmentation: What’s the Difference?
Melasma and hyperpigmentation share several common characteristics. Despite this, they’re different skin conditions with different causes, as well as separate treatment options.
Melasa is a specific form of skin discoloration that primarily affects women. As we’ve covered above, experts believe it’s caused by a variety of factors, from hormonal fluctuations to your level of UV exposure.
Hyperpigmentation, on the other hand, is a broad term that can refer to any type of darkening and skin discoloration.
Skin hyperpigmentation can be brought on by excessive sun exposure, from skin conditions such as psoriasis and eczema, and even from acne. It’s an umbrella term for a range of skin issues that can occur for a huge variety of reasons.
Because skin hyperpigmentation and melasma are caused by different factors, each condition has a different treatment. With a few minor exceptions, treatment options that are effective for hyperpigmentation usually won’t work as effectively (or at all) for melasma.
How to Get Rid of Melasma
Melasma can be a frustrating condition that affects everything from the appearance of your skin to your self-confidence.
Luckily, melasma is treatable. There are several treatments for melasma, ranging from topical skin creams to oral medications, laser treatments, chemical peels and more. We’ve listed all of these treatments below, along with information on the efficacy of each treatment option.
Non-Pharmaceutical Treatments for Melasma
Not all cases of melasma need to be treated using medication. Because melasma can occur as a result of stress, pregnancy or your use of hormonal birth control, some cases can be solved by making changes to your habits and lifestyle.
If you’ve developed melasma during pregnancy, dermatologists will usually recommend waiting for six to 12 months after giving birth before taking action. Most of the time, pregnancy-induced melasma fades on its own as your body’s hormone levels return to normal.
This is also true of medication-induced melasma, which typically fades over time as your body returns to normal hormone production. Birth control-induced melasma, for example, can often be treated by simply switching from the pill to a non-hormonal method of birth control.
If your melasma is triggered by sun exposure, your dermatologist might recommend avoiding sunlight exposure, limiting your time in direct sunlight, or using a strong, high-SPF sunscreen when you spend time outdoors.
While cosmetic products like makeup won’t heal melasma, you can use them to cover up skin that’s affected by melasma while you’re waiting for other treatment to take effect.
There’s no evidence that makeup can worsen melasma, meaning you shouldn’t need to make any changes to your makeup routine if you have melasma. Some makeup products, like high SPF foundation, can even help to prevent further UV-induced skin discoloration.
While these tactics are normally enough to treat mild melasma, they’re not always effective. If your melasma is more serious or persistent, your dermatologist might recommend a topical or oral medication.
Topical Treatments for Melasma
Topical medications can be highly effective at treating melasma. The most common first topical treatment for melasma is hydroquinone -- an organic compound that lightens skin and can help to even out the blotchiness and discoloration caused by melasma.
High-strength versions of hydroquinone are currently only available on prescription. However, you can purchase lower-strength hydroquinone cream over the counter in many pharmacies, making it a convenient option if you have mild to moderate melasma.
Studies show that hydroquinone is highly effective at treating melasma, particularly when used in combination with retinol. In a 2007 study, a hydroquinone/retinol cream produced “sustained improvements” in skin coloration over the course of 12 weeks as a treatment for melasma.
Another common topical treatment for melasma is tretinoin. Used topically, tretinoin can lighten patches of skin affected by melasma, reducing the visibility of melasma and producing a more even skin tone.
In a 1993 study, women with melasma were assigned to two groups, one of which received a non-therapeutic vehicle and the other a .1% tretinoin cream. After 40 weeks of treatment, the tretinoin users showed a significant improvement in skin colorimetry.
Tretinoin also has significant benefits as an acne and anti-aging treatment, making it one of several go-to topical treatment options for melasma.
Finally, dermatologists also occasionally prescribe corticosteroids for melasma. Corticosteroids are usually used to treat severe cases of melasma that don’t respond to topical treatments like hydroquinone and tretinoin.
Most of the time, corticosteroids are combined with other topical treatments such as tretinoin and hydroquinone for optimal results.
While effective, corticosteroids can produce a range of side effects when used over the long term. Because of this, most dermatologists will begin by treating melasma with retinoids and organic compounds like hydroquinone before considering corticosteroids.
Cosmetic Procedures for Melasma
Most of the time, topical medications like hydroquinone and tretinoin are enough to lighten the skin discoloration caused by melasma.
However, severe cases of melasma often don’t respond to topical treatments, or simply don’t respond enough for a topical treatment to be fully effective.
Cosmetic procedures are usually reserved for severe, persistent cases of melasma, meaning this isn’t where you’ll want to start your treatment. However, if topical treatments like tretinoin and hydroquinone don’t work, chemical peels and other procedures can be effective.
Chemical peeling is one of the most common cosmetic procedures used to treat severe and persistent melasma. A chemical peel works by peeling away the outermost layer of your skin, exposing the new skin cells and reducing the visibility of skin discoloration.
While most people think of chemical peeling as an anti-aging treatment, there’s plenty of data backing up its use for melasma.
Another common cosmetic procedure for melasma is microdermabrasion. Microdermabrasion works by speeding up your body’s skin cell turnover process, allowing new skin cells to replace the existing, discolored skin cells at a faster pace.
Like chemical peeling, microdermabrasion is backed up by a reasonable amount of scientific data as a melasma treatment. In a study from 2016, people with melasma showed a “mild to moderate” improvement in skin discoloration after microdermabrasion treatment.
In a 2012 study, 81% of the women treatment using microdermabrasion experienced a >75% clearance of melasma, with 40% experiencing clearance of 95% or more.
In short, cosmetic treatments like chemical peeling and microdermabrasion work, usually with lasting results. However, the cost of these treatments means they’re best used only if topical melasma treatments like hydroquinone and tretinoin aren’t fully effective.
Dealing with skin discoloration caused by melasma can be a stressful experience. Luckily, it’s not something you’ll have to face forever. From topical medications to cosmetic procedures, a variety of treatment options can improve and eliminate the effects of melasma on your skin.
Whether you’re dealing with mild melasma or severe skin discoloration, it’s important to stay focused on the long term. With consistent, regular treatment, most people with melasma are able to achieve big improvements in their skin coloration and appearance.
Add in some small changes to your habits -- such as wearing sunscreen, limiting your direct exposure to sunlight and carrying out occasional maintenance therapy -- and there’s a good chance that you’ll be able to manage and control your melasma for good.
Learn More About Melasma
Interested in learning more about how you can treat melasma? Our guides to hydroquinone and tretinoin for treating melasma look at two of the most effective topical products for treating and managing melasma.
Our guide to kojic acid and its effects on melasma covers how you can use an over-the-counter skin cream to treat and control mild to moderate melasma.