Concerned about a dark patch on your face that won’t go away? Melasma is a very common concern among young women, and is especially common among those with a darker skin type. We’ve received many questions about melasma treatments in AskDerm Letter, and we’d like to answer them here.
What is melasma, and who does it affect?
Melasma is characterized by dark patches of hyperpigmentation that form on the cheeks, upper lip, nose, and sometimes the forehead area. While the facial area is the most common site by far, other sun-exposed areas like the arms can also be affected.1 Typically, they form gradually over time and become more noticeable and prominent with time. Melasma is not a medical concern, but its appearance can be disturbing for the patient.
Melasma can affect anyone, but young women between the ages of 20 and 40 with light to darker brown skin can be considered a higher risk group. Hyperpigmentation (darkening of the skin that contrasts with overall skin tone) is a higher risk overall for people with naturally darker skin tones. Pregnancy will also be a trigger for many people as it affects hormone levels; melasma is often referred to as the mask of pregnancy for this reason.
What causes melasma?
While the exact mechanisms of melasma formation are unknown, two key factors are involved: Female hormones and sun exposure. Melasma mostly affects women for this reason, but it can occasionally affect men as well.2 Birth control pills, pregnancy, or various hormonal therapies can trigger a bout of melasma for many women, and estrogen levels or sensitivity to estrogen appear to be a cause of melasma. Sun exposure, however, is the direct trigger that activates the melanocytes (the cells that produce the dark pigment) and causes melasma.
Will melasma go away?
Melasma will sometimes disappear spontaneously, especially if it was caused by temporary hormonal changes like pregnancy or taking birth control pills. In many cases, once the pregnancy is over, or you stop taking birth control pills, the melasma subsides as well. Unfortunately, some will struggle with their melasma more than others, and which cases of melasma will go away and how fast they will go away is difficult to predict.
How do you treat melasma?
- Limit exposure to sunlight
- Use a broad-spectrum, high SPF sunscreen
- Topical treatments (tyrosinase inhibitors, bleaches)
Melasma will sometimes spontaneously disappear, especially if it’s triggered by pregnancy. Unfortunately, there is no easy and quick solution to melasma treatment. Patients should expect their melasma to improve slowly over months of treatment, provided that they continue to be vigilant with sun protection both throughout the treatment period and after the melasma has been successfully treated. Treatment generally consists of “bleaching” the dark spots with topical creams and lotions that contain actives that inhibit melanin (which creates color in human skin). In North America, hydroquinone is the most commonly used active for topical treatments.
What are the challenges of treating melasma?
Treatment of melasma is often very challenging. For many, treatment is slow to take effect, and in many cases, the melasma recurs even after successful treatment. Ongoing continuous sun protection is critical in treating melasma. Very often, a small amount of sun exposure can reverse the progress made with treatments. Sometimes even after successful treatment, sun exposure can bring the melasma right back, which can be incredibly frustrating.
- Patience is required, as many treatments take time to see changes.
- Meticulous sun protection is required. Sunscreens must have broad-spectrum protection as UVA light is what appears to trigger melasma.
- Topical treatments using hydroquinone, kojic acid, or azelaic acid are the most common.
- There are other treatments like chemical peels or laser treatments, but the evidence for their efficacy is less established, and high cost can also be an issue.
Treatment of melasma is often very challenging. For many, treatment is slow to take effect, and in many cases, the melasma recurs even after successful treatment. Ongoing continuous sun protection is critical in treating melasma. Very often, a small amount of sun exposure can reverse the progress made with treatments. Sometimes even after successful treatment, sun exposure can bring the melasma right back, which can be extremely frustrating.
2Men have female hormones as well but at lower levels and vice versa. About 90% of patients with melasma are female.