Melasma, previously known as chloasma, presents as gray-brown, irregularly shaped, persistent spots on the face. This is also a ‘photoaging’ condition, which means sun damage is causing your skin to age prematurely.
Melanocytes are important to produce the pigment ‘melanin’ which gives the color to your skin. In this condition, melanocytes get over active and produce copious amounts of melanin and gives the pigmented appearance. There are several factors that trigger melanocytes to cause chloasma.
What causes Melasma (Chloasma Faciei)?
Melasma is thought to be triggered by an overproduction of melanin by pigment-producing cells (melanocytes), which can be stimulated by ultraviolet (UV) light exposure. This explains why melasma is often more noticeable after sun exposure and can worsen in the summer. Hormonal changes play a key role, particularly during pregnancy (often called the “pregnancy mask”), and when taking hormonal contraceptives or hormone replacement therapy.
Thyroid disorders and some medications, including anti-epileptic drugs, may also contribute. Although melasma can affect anyone, women are more commonly affected, especially those with darker skin tones, such as people of South Asian, African, Mediterranean, or Middle Eastern descent. A family history can also increase the risk.
Symptoms
Melasma usually presents as flat, symmetrical patches of pigmentation on the skin, typically in shades of brown or grey-brown. These patches are not itchy or painful, but can be distressing due to their cosmetic appearance. They commonly appear on the cheeks, forehead, bridge of the nose, chin, and upper lip, and may also occur on sun-exposed areas such as the forearms and neck. In some individuals, there may be darkening of existing moles, freckles, nipples (areolas) or the appearance of a dark line along the midline of the abdomen (linea nigra), particularly during pregnancy.
Diagnosis is usually made by appearance, though a Wood’s lamp examination may be used in dermatology clinics to determine whether the pigmentation is confined to the epidermis or also involves the dermis. This distinction can help guide treatment options, as epidermal melasma tends to respond better to topical creams. A history of sun exposure or hormonal changes may support the diagnosis.
What can I do?
Even though there is no treatment for melasma, it may fade on its own. This often happens when the trigger is pregnancy or birth control pills. When the woman delivers the baby or stops taking the birth control pills, melasma may fade.
You can also protect the affected areas from the sun. You can wear sunscreen every and reapply it every 2 hours to achieve so. This is also important to prevent relapse of melasma after it fades away spontaneously or with treatment. Some dermatologists also recommend wearing a wide-brimmed hat when you are outside, as sunscreen alone may not give you all the protection you need.
When you are choosing the sunscreen, there are several things to consider. Especially, new evidence proves not only UV light, but also short wave length visible light rays (blue-violet) have the ability to cause melasma by inducing hyperpigmentation.5 So, it is important to go for a sunscreen that contains iron oxide, which provides protection against the latter type of waves.
Some studies show that folate deficiency can be related to hyperpigmentation. Therefore, you can try including green leafy vegetables, oranges, whole-wheat bread, and whole-grain cereal to your diet. You should also stop using skin care products that irritate the skin, as it may worsen melasma.
Should I seek medical care?
If self-treatment does not improve your situation or causes skin irritation and darkening, you should seek help from a dermatologist.
Treatment
Managing melasma can be difficult due to variable treatment outcomes and the high likelihood of recurrence. There is currently no definitive cure, and many treatments only target pigment-producing cells (melanocytes). Emerging evidence suggests melasma is related to chronic sun exposure and skin ageing, meaning that multiple skin components—not just melanocytes—may be involved. A combination approach targeting several contributing factors may improve future treatment outcomes.
Treatment options
Treatments are generally grouped into the following:
1. Topical depigmenting agents, such as hydroquinone, azelaic acid, kojic acid, and retinoids
2. Procedures, including chemical peels and microneedling
3. Laser and light therapies, which are used with caution due to potential side effects
These are often combined with strict sun protection to improve outcomes.
Specific treatments
Daily use of a broad-spectrum sunscreen (SPF 30 or above) is essential. Topical treatments, including hydroquinone (under prescription), azelaic acid, tretinoin and combination creams (such as hydroquinone with retinoids and mild steroids), may improve pigmentation. It often takes several months before visible improvement is seen.
