Melasma

Overview

Melasma is a common, harmless skin condition that causes patches of darker pigment, usually brown or gray-brown, most often on the face. It typically appears symmetrically on the cheeks, forehead, bridge of the nose, upper lip, and chin. Because it often develops during pregnancy, it is sometimes called the "mask of pregnancy."

Melasma happens when pigment-producing cells in the skin make too much melanin in certain areas. It is much more common in women and in people with naturally darker skin tones. While melasma poses no health risk and is not contagious, it can be persistent and distressing, and it tends to improve with sun protection and treatment but can return.

Because sunlight is such a strong driver of melasma, treatment works best when it is paired with consistent, year-round sun protection. Managing expectations is important too, since the patches usually fade gradually over weeks to months rather than disappearing quickly, and ongoing care is often needed to keep them from coming back.

Symptoms

Melasma causes changes in skin color but no physical discomfort. Typical features include:

• Flat, brown or gray-brown patches with irregular but fairly well-defined borders
• A symmetrical pattern, often on both cheeks, the forehead, nose, upper lip, or chin
• Patches that are more noticeable after sun exposure and may fade somewhat in winter
• No itching, pain, scaling, or roughness

The patches can sometimes appear on other sun-exposed areas such as the forearms and neck. Because melasma is purely a change in pigment, any patch that is raised, scaly, bleeding, or changing in an unusual way should be checked to rule out other skin conditions.

Causes

Melasma develops when melanocytes, the cells that produce skin pigment, become overactive and deposit excess melanin in patches. The main triggers are:

• Sun exposure: Ultraviolet and visible light stimulate pigment production and are the leading trigger and the reason melasma often worsens in summer.
• Hormonal changes: Pregnancy, oral contraceptives, and hormone therapy can bring it on or worsen it.
• Genetics: A family history makes melasma more likely.
• Skin type: It is more common in medium to darker skin tones.

Heat and certain skincare products or medications can also play a role in some people.

Risk Factors

• Being a woman, especially during the reproductive years
• Pregnancy or use of hormonal contraception or hormone therapy
• Medium to darker skin tones
• Frequent or unprotected sun exposure
• A family history of melasma

Diagnosis

Melasma is usually diagnosed by its appearance during a skin examination:

• Visual examination: A doctor or dermatologist recognizes the typical symmetrical facial patches.
• Wood's lamp examination: A special ultraviolet light can help show how deep the pigment lies, which guides treatment.
• Skin biopsy: Rarely needed, and used only if the diagnosis is uncertain or another condition is suspected.

Treatment

Melasma can be stubborn, and treatment works best when combined with strict sun protection. Options include:

• Sun protection: Daily broad-spectrum sunscreen, ideally tinted to block visible light, plus hats and shade. This is the foundation of every treatment plan.
• Topical lightening agents: Prescription creams such as hydroquinone, or combinations with a retinoid and a mild steroid, can fade the patches over time.
• Other topicals: Ingredients such as azelaic acid, tranexamic acid, vitamin C, and niacinamide may help.
• Procedures: Chemical peels, certain lasers, and microneedling are sometimes used, but cautiously, as aggressive treatment can worsen pigment.
• Stopping triggers: Reviewing hormonal medications with a doctor where appropriate.

Even with treatment, melasma often returns if sun protection lapses, so ongoing care is important.

Prevention and Self-Care

• Use broad-spectrum sunscreen every day, reapply regularly, and choose a tinted formula that blocks visible light
• Wear wide-brimmed hats and seek shade, especially during peak sun hours
• Be gentle with the skin and avoid harsh scrubs or irritating products that can worsen pigment
• Discuss hormonal contraception with your doctor if melasma is a problem
• Be patient, as fading takes weeks to months and consistency matters most

When to See a Doctor

See a dermatologist if facial pigmentation is bothering you, is spreading, or does not improve with sun protection, as prescription treatments can help. Melasma itself is not dangerous and is not an emergency.

Have any skin patch checked promptly if it becomes raised, scaly, itchy, bleeds, or changes in size, shape, or color in an unusual way, so that other skin conditions can be ruled out.

Related Topics

Frequently Asked Questions

References

1. American Academy of Dermatology. Melasma.
2. Mayo Clinic. Melasma.
3. MedlinePlus, U.S. National Library of Medicine. Melasma.
4. British Association of Dermatologists. Melasma.