Melasma—What It Is and How To Treat These Dark Patches on Your Face

The skin condition is particularly hard to treat, but there are ways to lessen the appearance of blotches.

Perhaps you noticed it in the mirror one day while doing your daily skincare routine or inspecting that rogue pimple that popped up out of nowhere: a blotch (or a few), just a shade or two darker from your actual skin color.

It's what's known as melasma. According to the American Academy of Dermatology (AAD), while it can affect anyone, melasma is most likely to occur in people with darker skin tones. It often appears during pregnancy. In fact, melasma is so common during pregnancy that it's sometimes called the "mask of pregnancy."

Though it can be difficult to treat (more on that later), melasma isn't dangerous from a health perspective. The patches can cause cause concern in those who've never seen them before though, so we asked dermatologists to give us the lowdown on melasma—including what you can do to make it go away (if that's what you want), and whether you can prevent it in the first place.

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What Is Melasma?

"Melasma is a skin condition that causes discolored, dark patches on the skin. These patches are darker than your skin tone, and tend to look brown or brown-ish gray," Annie Gonzalez, MD, a board-certified dermatologist at Riverchase Dermatology in Miami told Health.

These dark patches—known sometimes as hyperpigmentation, which is a more general term for skin discoloration—tend to show up on the face, mainly on the forehead, cheeks, and the upper lip (aka, a 'melasma mustache'), though it can also crop up on the back, neck, or forearms, Dr. Gonzalez said.

What Causes Melasma?

The short answer: Experts really don't know. "It's not fully known what the exact mechanism of action is that triggers melasma, but we do know that it's a combination of hormones, sun exposure, and genetics," Jordan Carqueville, MD, board-certified dermatologist and the founder and medical director of The Derm Institute of Chicago, told Health.

Sun exposure plays a primary role in all types of hyperpigmentation, melasma included; UV rays as well as visible light and heat kick melanocytes, the cells in our skin that produce pigment, into overdrive. To that point, people with darker skin are more susceptible to getting melasma, because they have a higher amount of active melanocytes in their skin to begin with, Dr. Gonzalez said.

That being said, the hormonal component is what sets melasma apart from other types of hyperpigmentation. More specifically, estrogen is the culprit, Dr. Carqueville said. It's why melasma so often occurs during pregnancy. Anywhere from 15% to 50% of pregnant people can end up developing melasma, especially during the third trimester, when estrogen levels are at their highest, Dr. Gonzalez said.

Pregnancy aside, Dr. Gonzalez added that stress can be a contributing factor as well. That's because stress increases the levels of the hormone cortisol in the body, which can then increase the amount of estrogen. Similarly, the estrogen effect is why birth control pills can also trigger melasma, and why it is so much more common in women than in men, Dr. Carqueville said.

So, Can You Prevent Melasma?

"You can't necessarily prevent melasma because it's influenced by factors such as hormones and genetics that can't really be controlled," Dr. Gonzalez said, who added that about 30% to 50% of people who have melasma say that someone else in their family has it, too.

There is a risk factor you can control, though: sun exposure. Both Dr. Gonzales and Dr. Carqueville underscored the fact that practicing safe sun is the absolute best thing you can do to keep melasma at bay.

That means using a broad-spectrum sunscreen with at least SPF 30 daily, reapplying the sunscreen every 2 hours when you are in continuous sun or if heading back outside. You can also try tinted sunscreen that contains iron, which helps block out visible light as well. In addition, you should wear broad-rimmed hats, seek shade, and generally avoid the sun as much as possible.

What Are the Best Treatment Options for Melasma?

Quick reminder: Melasma is a harmless condition, Dr. Gonzales said. That means it's an aesthetic concern entirely.

That said, if you aren't so jazzed about having some darker blotches on your face, there are a few treatment options, though the condition is very hard to treat. That's because, unlike other forms of hyperpigmentation which only exist on the epidermis (surface layer of the skin), melasma can be found even in the dermis (a deeper layer of the skin), Dr. Carqueville said.

For patients who are not pregnant (that's a biggie—these treatments are not safe for pregnant people), topical medications containing hydroquinone or kojic acid tend to have the highest success rates in lessening the appearance of melasma, Dr. Carqueville said.

Topical medications are applied on the skin and are available by prescription or over-the-counter. The ingredients hydroquinone and kojic acid specifically work by inhibiting the production of an enzyme needed in order for melanin, or pigment, to be produced.

In addition, topical retinoids, vitamin C, glycolic acid, cysteamine, as well as oral and topical tranexamic acid are among some of the treatments your healthcare provider might recommend, according to Harvard Medical School.

Microneedling and peels can also help; the peels help lift off some of the surface pigment, while the microneedling increases the absorption and efficacy of topical treatment products, Dr. Carqueville said.

Lasers can help, too—they're a good way to target and break up the pigment at various levels in the skin, though it's important to proceed with caution. Because heat can also trigger melasma, in needs to be a laser that isn't going to generate enough heat that's going to end up exacerbating the situation and making the melasma worse, not better, Dr. Carqueville said.

Luckily, there is an option that is safe and available for everyone, even pregnant people dealing with melasma: sun protection. Remembering to put on some SPF every single day can help to both prevent melasma and keep the melasma that's already shown up from getting any more noticeable.

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