Melasma is a common skin condition, particularly in women. It may lead to brownish skin patches on the face, in particular around the cheeks and the forehead. It may also manifest in a reddish-brown discoloration across the bridge of the nose, and sometimes on the chin.

While primarily related to sun exposure, hormone imbalances (or sudden, functional increases in estrogen production) can also trigger melasma. It is most common in women, particularly during pregnancy.

Common Risk Factors

  • dark skin tone
  • hormone therapy patient (includes oral contraceptives)
  • active pregnancy

Melasma often fades during the colder months of the year, but returns with brighter, sunnier weather. It may also fade with the end of a pregnancy, or with the cessation of any hormone therapy.

Melasma does not by itself cause irritation, sensitivity, or pain, but many people find its mottled appearance unsightly.

Individuals with naturally darker skin are more likely to experience melasma. This includes individuals, predominantly women, of Latin or Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent. The condition is not strictly hereditary, but individuals with blood relations who experienced melasma are considered more likely to experience it themselves.

What are the Causes?

Most likely, this condition arises when melanocytes in the skin produce too much color. This would explain why people with darker skin tones are more likely to experience melasma: they have more melanocytes.

Melasma is often triggered by changes to regular sun exposure, by pregnancy, or by the use of certain skin-care products. In particular, animal-based cosmetics can trigger melasma.

A dermatologist can usually diagnose melasma through simply looking at a patient's skin. On rare occasions, a biopsy may be necessary to make absolutely certain. This is typically the case where other existing skin concerns make standard diagnosis difficult.

Long Term Melasma Treatment

Sometimes, melasma doesn't go away on its own. In the case of its cause being hormone therapy or birth control, the patient may not be able to cease their medication. In such cases, there are treatment options for this persistent skin condition.

Hydroquinone: This topical gel, ointment or cream is applied to the skin and works by lightening the skin directly. Some medicines with hydroquinone are available over the counter.

Tretinoin and corticosteroids: A dermatologist may write a prescription to enhance skin lightening. These medications also come as a cream, and may include hydroquinone as well.

Azelaic acid or kojic acid: Prescription-strength skin lightening agents, shown to be effective in treating melasma caused by a variety of contributing factors.

Chemical peel, microdermabrasion, or dermabrasion: Performed by a dermatologist, these procedures, when taking the patient's skin type into account, are highly effective at treating melasma which has resisted topical ointments and other medication.

After melasma clears, a patient may need to maintain skin treatment to ensure that it does not recur. A dermatologist can advise on the subject directly. Remember to consult with a physician if any additional skin darkening, increased sensitivity, or other irritation occurs as a result of melasma treatment, as this may be a sign of an unrelated condition.