Melasma is a common skin pigmentation disorder that causes brown or grayish patches to appear on the skin, most often on the face. These patches usually develop on the cheeks, bridge of the nose, forehead, chin, and above the upper lip. Although melasma is not physically painful or itchy, it can have a major emotional impact. Many patients seek treatment because the discoloration is so visible and makes them feel self-conscious about their appearance.
This chronic condition is especially common in women, particularly during hormonal changes such as pregnancy, use of birth control pills, or hormone replacement therapy. Sun exposure is one of the biggest triggers for melasma, and daily protection from UV rays using sunscreen and sun-protective clothing is crucial in both prevention and treatment.
What Causes Melasma?
Melasma is caused by the overproduction of melanin, the pigment that gives your skin its color. While the exact reason why some people develop melasma and others don’t isn’t completely understood, several contributing factors have been identified.
Common Triggers and Risk Factors:
- Medications or Products: Certain cosmetics or medications may cause sensitivity to sunlight, increasing melasma risk.
- Sun Exposure: Ultraviolet (UV) light stimulates melanocytes (pigment-producing cells), making existing melasma worse and triggering new patches.
- Hormonal Changes: Pregnancy, birth control pills, and/or hormone replacement therapy can trigger melasma. In pregnant women, it’s often called the “mask of pregnancy.”
- Genetics: A family history of melasma increases your risk.
- Skin Tone: Individuals with medium to dark skin types are more likely to develop melasma.
What Does Melasma Look Like?
Melasma typically presents as flat, irregular patches of darker skin. The pigmentation is usually symmetrical and appears most often on:
- Cheeks
- Forehead
- Bridge of the nose
- Upper lip
- Chin
Less commonly, melasma can affect other areas of the body that are exposed to the sun, such as the forearms and neck.
Melasma is not associated with any pain or itching. However, because it affects visible areas, especially the face, it can take a toll on a person’s self-esteem and emotional well-being.
How Is Melasma Diagnosed?
A dermatologist can typically diagnose melasma with a simple physical exam. In some cases, a Woods lamp examination may be used to better understand the depth of the pigmentation. Rarely, a skin biopsy may be performed to rule out other skin conditions.
Treatment Options for Melasma
Melasma is a chronic condition, meaning it can be managed but not always cured. The most important first step is to protect your skin from further UV exposure.
First-Line Defense: Sun Protection. The importance of strict sun protection cannot be overstated!
- Before starting any treatment plan, it’s critical to apply a broad-spectrum facial sunscreen (SPF 30 or higher) every single day, even if staying indoors. Even minimal exposure to sunlight can trigger a flare or worsen existing pigmentation.
- Look for a sunscreen that includes zinc oxide or titanium dioxide, which physically block UV rays. Reapply every 2 hours if you’re outdoors.
- Tinted sunscreen/SPF is better than non-tinted SPF because it will also protect against visible light from phones, tablets, overhead lights, and screens. It is the iron oxide used to color the tinted sunscreen that provides the additional protection, so make sure that iron oxide is an ingredient in your tinted sunscreen (some products use dyes instead of iron oxide).
Once sun protection is in place, your dermatologist may recommend one or more of the following options:
Topical Medications
- Hydroquinone: A skin-lightening agent that can reduce dark spots over time
- Tretinoin: A retinoid that promotes cell turnover and improves skin tone
- Corticosteroids: Sometimes combined with hydroquinone and other medications to reduce inflammation
- Tranexamic Acid: Newer treatments include this topical medication shown to reduce melasma pigmentation
- Azelaic Acid or Kojic Acid: Alternatives for those who can’t tolerate hydroquinone
Chemical Peels
- Superficial chemical peels can help exfoliate the top layers of skin, revealing a more even tone. These are usually performed in the office and may include glycolic acid, salicylic acid, or TCA peels.
- The right peel or series of peels can make an immense difference when it comes to reversing unwanted pigmentation. Our licensed medical aesthetician is an expert in managing melasma and can help tailor a treatment plan that will give you the best results.
Laser and Light Treatments
- Laser therapy and intense pulsed light (IPL) are sometimes used, but must be approached cautiously, particularly for darker skin types, because these treatments can worsen pigmentation if not done properly.
Oral Therapies
- In more stubborn or widespread cases, oral tranexamic acid may be prescribed under medical supervision. This treatment is still being studied but has shown promise in clinical settings.
- Spironolactone targets hormonal, inflammatory, and pigment-producing pathways that contribute to pigmentation caused by melasma, especially in hormonally sensitive skin.
Managing Melasma Long-Term
Because melasma is influenced by sun and hormonal triggers, even after successful treatment it can return. Ongoing maintenance is key.
Tips for Managing and Preventing Melasma:
- Use sunscreen all the time, every day, rain or shine, summer or winter, weekdays or weekends, lazy or busy.
- Wear a wide-brimmed hat and sunglasses when outdoors.
- Avoid being outside during peak sun hours between 10 AM and 4 PM.
- Choose non-irritating skin care products free from fragrance and alcohol (like lotions). Opt for creams instead, which do not contain alcohol.
- Ask your OB/GYN about alternatives to hormone-based birth control.
- Stick to a consistent skincare routine.
With a personalized treatment plan and a strong commitment to sun protection, many people can successfully manage their melasma and restore confidence in their skin.
When to See a Dermatologist
If you’ve noticed new dark patches on your face or are struggling to manage melasma on your own, it’s time to consult a professional. Early diagnosis and treatment can help you achieve the best possible results and prevent the condition from worsening. You don’t have to let melasma control your confidence. Our expert dermatology team is here in Denver/Lakewood to guide you through every step, from diagnosis to personalized treatment options. We understand that every patient’s skin is unique, and we’re committed to helping you find the safest, most effective path to brighter, more even-toned skin.