Melasma is a common pigmentation disorder that causes patches on the skin, primarily on the face. These patches appear darker than the surrounding skin.

Melasma is a skin condition that causes patches to appear, typically on the face, that are darker than a person’s skin tone. Melasma can be found primarily in individuals with light brown skin to darker skin tones, especially in areas with high sun exposure. Women are particularly susceptible to melasma, and it can appear as brown patches on the face, especially the cheeks, nose bridge, and forehead.

The most common areas for melasma to appear on the face include:

• The bridge of the nose
• The forehead
• The cheeks
• The upper lip
• The chin

Melasma may also appear on other areas of the body, especially those exposed to a lot of sunlight. These areas may include:

• The forearms
• The neck
• The shoulders

Females and those who are pregnant are at greater risk of developing melasma. Taking certain medications can also contribute.

Doctors do not fully understand why melasma occurs. It may be due to the malfunction of the melanocytes (the color-making cells) in the skin, causing them to produce too much color in certain spots.

As a result, people with light brown skin to darker skin tones may be more likely to develop melasma as they have more melanocytes than people with lighter skin do.

Risk factors Sun exposure. Frequent exposure to UV rays can trigger melasma.

• Skin color: Melasma occurs most commonly in people with light brown skin tones, particularly if they live in areas with high levels of sun exposure.
• Female sex: Melasma affects females about 9 times more than it does males.
• Pregnancy: Melasma is more common during pregnancy, affecting 15% to 50% of pregnant people. This may be due to pregnancy hormones.
• Genetics: Up to 50% of people with melasma report that close relatives also have the condition.

Potential triggers for melasma can include:

• Changes in hormones during pregnancy (chloasma)
• Hormone treatment or taking birth control pills
• Sun exposure
• Certain skin care products, if they irritate a person’s skin
• Some medications, including anti-seizure medications and those that make the skin more sensitive to sun exposure, such as includes retinoids, some blood pressure medications, and certain antibiotics

The primary symptom of melasma is hyperpigmentation — the development of discolored patches of skin or uneven skin tone. These patches are typically flat and appear darker than an individual’s skin tone, often brown or gray in color.

While melasma does not cause any other physical symptoms, some people may find the appearance of these patches bothersome. Patches caused by melasma should not cause physical pain.

Patches most commonly appear on the face. Common locations include the upper lips, bridge of the nose, cheeks, and forehead.

Less commonly, a person may also have patches on their arms and neck.

It is important to note that melasma is not a form of skin cancer, though it may sometimes look like other skin conditions. It is best to consult a doctor for diagnosis and treatment.

Dermatologists find most cases of melasma easy to diagnose during a visual examination. However, since melasma can resemble other skin conditions, a doctor may take a small biopsy during the initial visit. This may help rule out other conditions.

A biopsy involves removing a very small portion of the skin for further examination in a laboratory.

A doctor may also use a device called a Wood’s light to look more closely at the skin.

Treatment is not always necessary for melasma.

If hormonal changes, such as those that occur during pregnancy or while taking birth control pills, have caused melasma, it will fade after delivery or once a person stops taking the pills.

To prevent melasma, a doctor will likely recommend a high-SPF sunscreen.

For other people, melasma can last for years or even for the rest of their lives. If melasma does not fade over time, a person can seek treatment to help remove or fade the patches.

However, not all treatments work for everyone, and melasma may come back even after successful treatment.

Treatment options for melasma can include:

Hydroquinone

Doctors often use hydroquinone as the first line of treatment for melasma. Hydroquinone is available as a lotion, cream, or gel. It works by lightening the color of the skin patches.

A person can apply the hydroquinone product directly to the patches of skin that are discolored or uneven.

Hydroquinone is available as a prescription.

Corticosteroids and tretinoin

Corticosteroids and tretinoin come in creams, lotions, or gels. Both corticosteroids and tretinoin can help lighten the color of the melasma patches.

Combined creams

In some cases, a doctor may choose to prescribe combination creams that may contain hydroquinone, corticosteroids, and tretinoin in one. These are called triple creams.

Additional topical medications

In addition to or instead of other medicated creams, a doctor may also prescribe azelaic acid or kojic acid. These acids work to lighten the dark areas of skin.

Medical procedures

If topical medications do not work procedures such as:

• Chemical peel
• Laser treatment
• Light therapy

Some of these treatment options have side effects or may cause additional skin problems. It is best to speak with a doctor about possible risks.

If a person has had melasma before, they can try to avoid triggers by:

• Limiting sun exposure
• Wearing a hat when outside
• Using sunscreen

Outlook for melasma

Melasma causes dark patches to form on the skin, most often on the face. While these skin changes are harmless, some people may find them bothersome.

Treatment is effective for some people. Melasma that is due to hormonal changes may also fade over time, once hormone levels return to normal.

Taking steps to limit sun exposure such as wearing a hat and sunscreen may help prevent melasma.