Melasma
What is melasma?
Melasma is a skin condition that causes patches and spots, usually on the face, which are darker than your natural skin tone. While common, melasma can be mistaken for another skin condition. Board-certified dermatologists have the expertise required to give you an accurate diagnosis and individualized treatment plan.
Is melasma contagious? No
Melasma is most common in women
Many women first see these blotchy patches and freckle-like spots on their face during pregnancy or when they start taking birth control pills. Melasma is so common during pregnancy that it’s sometimes called the “mask of pregnancy.”
For some women, the melasma goes away after their baby is born or they stop taking birth control pills.
Melasma often begins during pregnancy
The blotchy brownish areas and freckle-like spots on this woman’s face are melasma, which first appeared while she was pregnant.
Women who have medium to dark skin tones are most likely to develop melasma. When melasma appears, it can cause tan, brown, grayish brown, or bluish gray patches and freckle-like spots. These usually appear on certain areas of face like the cheeks, forehead, chin, and even above the upper lip. While less common, melasma can develop on the arms, neck, or elsewhere.
What can get rid of melasma?
While melasma may go away on its own, this skin condition can also last for years.
If you dislike the discoloration on your skin caused by melasma certain treatments can sometimes help. Dermatologists recommend treating melasma sooner rather than later. It can be difficult to get noticeable results from treatment if you’ve had melasma for many years.
However, if you are pregnant, wait until you have your baby to treat melasma. If you use a melasma treatment that you can buy without a prescription, it can be difficult to know whether it’s safe to use during pregnancy. Also, melasma may improve and sometimes even go away after you give birth.
Is there a cure for melasma?
Treatments such as creams can help fade the discoloration, but treatments cannot make melasma go away forever. This skin condition can come back. It's common for melasma to return when you spend time outdoors without protecting your skin from the sun.
In fact, many people who have melasma say the dark spots and patches become more noticeable during the summer and fade in winter. For this reason, it is important to use sunscreen every day and wear a wide-brimmed hat to keep the spots from getting darker or returning.
Is melasma a type of cancer?
No, melasma is not a type of cancer. It’s also not a sign of skin cancer. Melasma differs from skin cancer in that it typically feels flat and appears on both sides of your face.
How can a board-certified dermatologist help with melasma?
If you have discolored patches or freckle-like spots on your skin, seeing a dermatologist can help ease your mind. A board-certified dermatologist can tell you whether melasma or another condition is causing the skin discoloration.
If you have melasma, a dermatologist can create an individualized treatment plan for you. Treatment usually begins with sun protection and creams that you apply to the melasma.
Many people who have a darker skin tone see a dermatologist for melasma treatment. In fact, treatment for melasma is one of the most common reasons that people who have a darker skin tone see a dermatologist.
Dermatologists understand that treating melasma in darker skin tones requires a different approach from treating melasma in lighter skin tones. For example, some melasma treatments can irritate darker skin, which can worsen melasma and make it darker.
Dermatologists know which precautions to take to prevent treatments from worsening melasma in darker skin tones. They also understand that it usually takes longer to see results from treatment if you have a dark skin tone.
It’s important to know that no matter your skin tone, melasma can be stubborn. Some people need a prescription strength-cream, procedure, or both.
If you use a non-prescription melasma treatment, dermatologists recommend using it for no longer than three to six months
If you don’t get the results you want by then, see a dermatologist for treatment.
A dermatologist can also help you with sun protection. To get results from treatment, you need to protect your skin from the sun every day.
Where does melasma develop on the body?
Melasma primarily develops on the face, usually on one or more of the following areas:
Cheeks
Chin
Forehead
Nose
Above the upper lip
Occasionally, people develop melasma on their jawline, neck, arms, or elsewhere.
Wherever melasma appears, it causes blotchy patches and spots that can look like freckles. The color varies with a person’s skin tone and the severity of the melasma. In general, melasma is slightly darker than your natural skin color. Most people see various shades of brown. Melasma can look bluish gray in people with darker skin tones.
What are the signs and symptoms of melasma?
The following pictures show what melasma can look like.
Melasma causes patches and spots that are darker than your natural skin color
This woman has melasma on her cheek, chin, above her upper lip, and next to her ear.
Melasma develops on both sides of the face
If you have melasma on your cheeks, you’ll see patches or spots on both cheeks, as shown here. This woman also has melasma on her nose, chin, and above her upper lip.
Melasma can cover a large area
The unevenly shaped patches of melasma can join together, creating one or more large areas of melasma.
Melasma can be more noticeable in one area than another
This woman’s melasma is most noticeable along her jawline. When melasma appears along the jawline, it may be a sign that the skin has been badly damaged by the sun’s rays.
Melasma can appear on the sides of the face
You may see patches like those shown here on the sides of this woman’s face, chin, and above her eyes.
People with a light skin tone can develop melasma
The light brown patch in the center of this person’s forehead is melasma.
Melasma becomes more noticeable when you spend time in the sun
While less common, melasma can develop on the arms, as shown here. Regardless of where melasma appears on your skin, it tends to become more noticeable when you spend time in the sun. Protecting your skin from the sun can help fade dark patches and spots.
Men develop melasma
While melasma primarily affects women, some men develop melasma. This man has melasma in common places like his cheeks, chin, forehead, and above his upper lip.
Melasma isn’t painful or itchy
While this skin condition can be noticeable, you won’t feel anything on your skin. Melasma won’t make your skin itch or cause pain.
While your skin doesn’t feel different, melasma can take a toll on your emotions. Having melasma makes some people feel self-conscious. Studies show melasma can lower self-esteem because it affects your appearance.
If you dislike the way melasma looks, treatment can help. Any treatment plan for melasma will include sun protection. That’s because the sun’s rays play a role in causing melasma.
Melasma often begins during pregnancy
Levels of the hormones increase during pregnancy, and this increase is believed to trigger melasma in some people.
What causes melasma?
More research is needed to fully answer this question. Researchers have discovered that when someone has melasma, the cells that give skin its color (melanocytes) tend to be more active. Exactly why this happens isn’t well understood.
It may be that melasma develops when something triggers these skin cells, causing them to go into overdrive.
The list of possible melasma triggers includes:
Sunlight: When sunlight hits our skin, it triggers the body to produce more melanin. This seems to explain why melasma develops on skin that gets the most sunlight like skin on the face, neck, and arms.
Pregnancy: An increase in the hormones estrogen and progesterone, which occurs during pregnancy, is thought to trigger melasma.
Some medications: The following medications may trigger melasma in some people:
Anti-seizure medications
Birth control pills (also known as oral contraceptive pills)
Medications that make your skin more sensitive to sunlight (includes retinoids, some antibiotics, and some blood pressure medications)
Stress: While this is controversial, some research findings suggest that stress can trigger melasma. Stress causes the body to make more of the hormone cortisol. An increase in cortisol may trigger melasma.
Tanning beds: A tanning bed or sunlamp tends to produce stronger ultraviolet (UV) rays than sunlight. When you expose your skin to UV light, it triggers the body to produce more pigment. Sometimes, this pigment appears unevenly, causing the blotchy patches and freckle-like spots of melasma.
Thyroid disease: Your thyroid is a gland located in your neck. It makes hormones that help your body with important jobs, including breaking down food you’ve eaten and regulating how fast your heart beats. If your thyroid gland develops a problem, this may increase your risk of developing melasma. Sometimes, treating the thyroid problem clears up the melasma.
Some people have a greater risk of developing melasma
Why a trigger causes melasma in some people but not others isn’t entirely clear. We do know that some people have a higher risk of developing melasma. You have a greater risk if you:
Are a woman between the ages of 20 and 40: Melasma is much more common in women than men. Hormones seem to play a role in causing melasma.
Have a medium or dark skin tone: Melasma develops more frequently in these skin tones than in lighter skin tones. You’re more likely to develop melasma if you are a woman of Latin, Asian, Black, or Native American heritage.
Have a blood relative who has melasma: Several studies have found that patients with melasma often have one or more blood relative(s) who also had melasma.
In one study of 324 melasma patients around the globe, 48% reported that they have a blood relative with melasma. Other studies have reported similar numbers.
If something is triggering melasma, it may clear on its own. This often happens after a person gives birth or stops taking a medication that triggers the melasma.
Sometimes, melasma stays around for years. If melasma bothers you, a dermatologist can talk with you about treatment options. Many treatment advances have been made in recent years.
If you notice uneven color on your face, seeing a dermatologist can help
Your dermatologist can tell you whether you have melasma or another condition and what may help you see clearer skin.
How do dermatologists diagnose melasma?
A dermatologist can often diagnose melasma by looking closely at your face and neck.
To get a close-up look, your dermatologist may use a specialized device like a Wood’s lamp or dermatoscope. Placed on (or near) your skin, these devices help your dermatologist see how deeply the darker pigment reaches into the layers of your skin. This knowledge is extremely helpful if you want to treat melasma.
Sometimes melasma can look like another skin condition. To rule this out, your dermatologist may perform a skin biopsy, which involves removing a small bit of skin. Your dermatologist can safely and quickly perform a skin biopsy during your office visit.
Melasma can affect how you feel about yourself
To find out how melasma affects your life, your dermatologist may ask questions or give you a questionnaire.
How do dermatologists treat melasma?
Melasma may go away on its own. This usually happens when a trigger, such as pregnancy or a medication, causes melasma. When you deliver your baby or stop taking the medication, melasma can fade.
Melasma can also last for years, or even a lifetime. While melasma cannot harm your body, it’s understandable that many people want to treat it.
There is no one best treatment for melasma
Often, the most effective treatment combines sun protection with medications that you apply to your skin — and sometimes a procedure.
If you want to treat melasma, be sure to ask your dermatologist about the cost of treatment. As treatment for melasma is not considered medically necessary, most insurers will not cover the cost.
If you decide to treat melasma, your dermatologist will create a treatment plan tailored to your needs. This means your plan will consider your skin tone, how deeply the melasma reaches into your skin, and any melasma triggers you may have. Sunlight, taking birth control pills, and even stress can trigger melasma.
The goals of treatment are to:
Decrease how much pigment your body makes.
Even out your skin tone, restoring it to your natural color.
To achieve these goals, a treatment plan often consists of:
Sun protection: Sunlight causes the skin to make more pigment, which can darken existing melasma and cause new patches.
Your dermatologist will tell you how to protect your skin from the sun. This often involves wearing a wide-brimmed hat while outdoors, seeking shade, and applying a broad-spectrum sunscreen (SPF 30 or higher) throughout the day.
For patients who have melasma, dermatologists often recommend using a sunscreen that contains:
Zinc oxide
Titanium dioxide
Iron oxide
Sun protection can help fade melasma and prevent it from returning
If you’re tempted to skip the sunscreen because it leaves a white cast on your skin, consider using a tinted sunscreen.
Medication and procedures: Your dermatologist may prescribe a medication that can decrease the excess pigment in your skin. Most patients receive a prescription for medication that they apply to their skin at home.
Your dermatologist may prescribe one or more of the following:
Hydroquinone: This is a common treatment for melasma. It is applied to the skin and works to even out the skin tone. Hydroquinone is no longer available in products that you can buy without a prescription.
Tretinoin and a mild corticosteroid: This combination contains a retinoid and an anti-inflammatory, which can even out skin tone.
Triple combination cream: This cream contains three medications — tretinoin (a retinoid), a corticosteroid to reduce inflammation, and hydroquinone to even out your skin tone.
Other medications: Your dermatologist may prescribe a medication that’s gentler on your skin like azelaic acid, kojic acid, or vitamin C.
When using makeup to hide melasma, it’s important to apply everything in the right order to get the best results. Here’s the order that dermatologists recommend:
Melasma medication
Sunscreen
Camouflage makeup
It takes time to see results from treatment, so your dermatologist may recommend using camouflage makeup until your melasma fades
If you haven’t used camouflage makeup before, your dermatologist can give you tips for getting natural-looking results.
Even when you follow your treatment plan, melasma can be stubborn. Some people still see melasma. Researchers have been studying this problem, which has led to several treatment advances.
To improve your results, your dermatologist may add one or more of the following to your treatment plan:
Chemical peel: During this procedure, your dermatologist applies a chemical solution to the melasma. This can help remove excess pigment.
Microneedling: This minimally invasive procedure creates microscopic tears in your skin. As the skin heals, it tends to have a more even skin tone.
Laser and light treatments: A few studies have found that adding a laser or light treatment can improve results for patients who are already applying medication to their skin and protecting their skin from the sun.
Platelet-rich plasma: This procedure involves taking a small amount of your blood, placing the blood into a machine that separates the blood into layers, and then injecting the layer of blood known as plasma into the skin with melasma. This can help even your skin tone.
Only a board-certified dermatologist should perform the above procedures. Getting the desired results requires in-depth knowledge of the skin. A board-certified dermatologist has the training required to select the right procedure for each patient, counsel you on what to expect, and perform the procedure safely.
Are you looking for a dermatologist who focuses on darker skin tones?
Go to Find a Dermatologist, click on Any Practice Focus, and select Skin of Color.
Sometimes, melasma is extremely difficult to treat. When this happens, your dermatologist may talk with you about adding the following medication to your treatment plan:
Tranexamic acid: You may apply this medication to your skin or take it as a pill. In studies, tranexamic acid has been shown to decrease the patches of melasma when other treatments fail to work.
If tranexamic acid is prescribed, it’s usually prescribed as a pill that you take twice a day. Patients prescribed this medication often also use the triple combination cream, sun protection, and makeup that contains iron oxide.
Before prescribing this medication, your dermatologist will talk with you about your health. If you’ve had a blood clot, be sure to tell your dermatologist.
Results take time
When you follow your treatment plan, it usually takes between 3 to 12 months to see results. It may take longer if you’ve had melasma for a long time.
3 ways to make melasma less noticeable
Melasma is a common skin problem that causes brown, tan, grayish brown, or bluish gray patches on the face, depending on your skin tone. Although the exact causes of melasma are unclear, common triggers include sunlight, pregnancy, and birth control pills.
If you have melasma, dermatologists recommend the following tips for achieving a more even skin tone:
Protect your skin from the sun every day. One of the most common treatments for melasma is sun protection.
Since sunlight triggers melasma, it is important to protect your skin every day, even on cloudy days and after swimming or sweating. Whenever possible, seek shade when outdoors and wear sun-protective clothing, such as a wide-brimmed hat and sunglasses with UV protection. For more effective protection, select a hat that has an ultraviolet protection factor (UPF) number on the label.
Apply sunscreen to all skin not covered by clothing. Choose a sunscreen that offers:Broad-spectrum protection
Water-resistance
SPF of 30 or more
Zinc oxide and/or titanium dioxide to physically limit the effects of the sun’s rays on your skin and iron oxide
Apply sunscreen 15 minutes before going outside, and reapply it at least every two hours.Along with protecting your skin from the sun, you need to stay out of tanning beds and never use sunlamps
Indoor tanning devices can worsen melasma and prevent treatment from working.
Choose gentle, fragrance-free skin care products. If a skin care product burns or stings when you use it, the product is irritating your skin. This may darken dark spots.
Avoid waxing. It’s important to avoid waxing areas of the body with melasma. Waxing may cause skin inflammation, which can worsen melasma. Ask a dermatologist about other types of hair removal that may be right for you.
If your melasma does not go away, see a board-certified dermatologist to discuss available treatments for melasma, such as prescription medications or in-office procedures.