Even if you've never heard of the condition, chances are you've seen—or probably even know—someone with melasma. Perhaps you're thinking that you might have this common condition. Read on to find out what causes melasma and what you can do about it.

What Is Melasma?

Melasma is a skin condition characterized by facial hyperpigmentation, or darkening of the skin. It most commonly affects women with darker skin tones, which Dermatologists know as types IV through VI on the Fitzpatrick skin color scale. Melasma typically presents as symmetrical patches of discoloration that range from tan to light brown and appear on the forehead, cheeks, and upper lip. For some individuals, it also appears on the shoulders, back, and other parts of the upper body.

The exact cause of melasma is unclear, and it can be challenging to treat. Although it can take a toll on one's confidence and self-esteem, the condition is not dangerous in itself. A Dermatologist will usually be able to diagnose a patient after a visual exam. In some cases, skin samples may be taken to ensure the symptoms aren't the result of another disorder.

What Causes Melasma?

The direct cause of the skin discoloration is overactive melanocytes, the pigment-producing cells in the skin. The root cause of the condition, however, has proven hard to pinpoint. Risk factors and possible triggers include:

  • Sex: Of all observed cases, about 90 percent are found in women.
  • Skin color: Those with melasma tend to have darker skin.
  • Light exposure: Those with a history of sun (and even artificial light) exposure are vulnerable.
  • Hormones: Oral contraceptive pills or pregnancy can bring on the condition.
  • Family history: Melasma has been observed to run in families.

Finally, it's important to note that melasma waxes and wanes—skin tends to become lighter in the winter and darker in the summer, most likely due to patients receiving more and stronger ultraviolet (UV) radiation in the summertime.

Is Melasma the Same as Hyperpigmentation?

Yes and no. Melasma is just one of several types of pigmentation disorder and may look very similar to sun freckles or dark spots caused by acne or other conditions. It is, however, different. For example, we know that discoloration caused by acne (a condition which should resolve itself over time) is due to infection and inflammation that leads to more melanin in the skin.

Conversely, melasma is more complex in its root cause, and dealing with this type of hyperpigmentation condition will not necessarily be the same as dealing with another form.

Treatment and Prevention of Melasma

Although melasma is incurable, there are a few different options for treatment, each of which focuses on one of three main goals:

  • Remove any potential underlying trigger (like birth control pills)
  • Remove any extra pigment causing the unwanted darkening with lightening agents (similarly to how we treat other causes of hyperpigmentation)
  • Protect against any further damage

Although it's tempting to cover it up with concealer or seek a solution based on your own research, you're best off relying on your Dermatologist when it comes to treatment. They may simply advise you to change your behavior, medication, or skin care products, or they might think something more is appropriate—for example, lightening skin with a treatment such as hydroquinone or a chemical peel. If necessary, they can build a regimen for you consisting of treatments like topical retinoids, kojic acid, and alpha-hydroxy acids or a carefully selected combination of these.

Finally, protecting yourself from the sun is arguably just as important (if not more so) than topical treatment. It's also the easiest method of treatment and something you should make part of your routine for reasons beyond the cosmetic. Since many cases of melasma seem to be induced by both UV radiation and visible light, Dermatologists recommend that a sunscreen with an SPF of 30 or higher be used daily. Darker-skinned individuals trying to avoid the pale appearance that can sometimes come with sunscreens should consider a tinted formula.

See a Dermatologist if you're concerned about melasma, and know going into the discussion that there is not a single fix-all therapy. The most effective treatment often involves a combination of prevention, products, and procedures. Your Derm will be happy to talk to you about the issue and start you on a path to looking and feeling your best.


  • Dr. Jenny Liu (@derm.talk)

    Dr. Jenny Liu is a board-certified Dermatologist and an assistant professor of dermatology at the University of Minnesota in Minneapolis. Her blog, DermTalkDocs.com, combines her professional and personal passions—dermatology and medicine, medical education, skin care, fashion, and motherhood.

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