Is melasma cosmetic?

Is melasma considered cosmetic?

For treatment and insurance purposes, usually yes. Treatment aims to reduce excess pigment and even out skin tone rather than prevent physical harm. Most insurers do not cover melasma treatment, so the word cosmetic can do quite a lot of work on a bill. Ask about costs before starting treatment; chemical peels, microneedling and laser treatments are also usually unavailable through the NHS.34

You can choose whether to treat confirmed melasma. Being upset by its appearance is a valid reason to discuss treatment, and a dermatologist can ask how much it affects your life. Cosmetic describes the purpose of treatment, not how much the condition matters to you.3

What does melasma look and feel like?

Melasma causes flat brown or greyish patches, usually on the cheeks, forehead, nose, upper lip or chin. Patches often appear on both sides of the face. Melasma does not normally itch or hurt, is not contagious and does not turn into skin cancer.45

The harmless description applies to melasma, not every dark patch. Some skin cancers can resemble melasma, so get persistent facial darkening checked rather than diagnosing it yourself. Tell your doctor about a patch that changes, or skin that becomes painful or itchy. A dermatologist usually diagnoses melasma by examining the skin and sometimes uses a special light or a small skin sample to distinguish it from other conditions.3456

Will melasma go away without treatment?

Melasma associated with pregnancy or hormone medicines can fade over several months after pregnancy ends or the medicine is stopped. Other cases last for years. Discuss a suspected medication trigger with the prescriber rather than stopping treatment yourself. Melasma can return with another pregnancy, renewed hormone use or sun exposure.57

There is no current cure, although treatment can improve the appearance. Pigment near the skin's surface generally responds better than deeper pigment, and mixed melasma often improves only partly. Treatment usually takes 3 to 12 months to show results, sometimes longer for longstanding melasma.234

What can you do day to day?

Protect your skin from sunlight every day, including in winter and on cloudy days. Use shade, a hat and a broad spectrum, water resistant sunscreen with SPF 30 or higher. SPF 50 or higher is also recommended for melasma. Choose a tinted sunscreen containing iron oxide for protection against visible light. Apply sunscreen 15 minutes before going outdoors and reapply at least every two hours, including after swimming or sweating. Avoid tanning beds and sunlamps.157

Choose gentle, fragrance free skincare. Stop using a skincare product that burns or stings: irritation can darken the patches. Camouflage makeup hides the colour rather than treating it, which gives makeup a fairly clear job description. If you use prescribed melasma medication, apply it first, then sunscreen, then camouflage makeup.347

What needs medical supervision?

Hydroquinone and prescription combination creams need medical supervision. Long term hydroquinone use can cause lasting darkening. Avoid hydroquinone and retinoid creams during pregnancy, and discuss suitable alternatives with your clinician. Peels and lasers can worsen pigmentation or cause lighter patches and scarring, so seek an experienced, qualified provider rather than treating a cosmetic concern as a risk free procedure.124