Melasma vs chloasma: What is the difference?

Why are there two names?

Melasma is the preferred term because chloasma comes from a Greek word meaning "to become green," rather than brown. The older name describes the same pigmentation, a vocabulary expansion that does nothing useful for your bathroom shelf.3

What does melasma look and feel like?

Melasma typically causes flat, irregular brown or bluish gray patches on both sides of the face. Common locations include the cheeks, forehead, nose, chin and above the upper lip. The patches do not usually itch or hurt. Melasma is not contagious or cancerous, but other conditions can resemble it, so appearance alone is not a reliable diagnosis at home.145

Does melasma only happen during pregnancy?

No. Melasma can affect anyone, including men, although it is more common in women and people with brown skin or skin that tans easily. Pregnancy, hormonal contraception and hormone replacement therapy are associated with melasma. Sunlight also promotes pigmentation. Melanin, the pigment that gives skin its colour, builds up in the affected areas; hormones are not the only factor.146

Pigment depth matters more than the name

Epidermal melasma involves pigment in the outer skin layer and generally responds better to treatment. Dermal melasma involves deeper pigment and responds less well. Mixed melasma involves both layers and often improves only partly. A clinician can examine the patches, sometimes using a Wood's lamp, which shines ultraviolet light to help assess the pigmentation.136

What should you do about it?

1. 1Protect your skin every day, throughout the year. Choose a broad spectrum SPF 50 or higher sunscreen containing iron oxides for protection relevant to melasma.
2. 2Apply sunscreen before going outdoors and reapply at least every two hours while in the sun. Wear a wide brimmed hat and avoid strong midday sun.
3. 3Have persistent facial darkening assessed before choosing a lightening treatment. If pigmentation began while taking hormone medicine, discuss the medicine with your prescriber rather than stopping it yourself.

Treatment options include azelaic acid and prescribed combinations of hydroquinone, tretinoin and a corticosteroid. Combination creams can outperform hydroquinone alone, but there is no single best treatment for everyone. Hydroquinone needs medical supervision because prolonged use can cause lasting darkening. Peels and lasers also need expert care: they can worsen pigmentation. Stop a product that causes irritation and seek advice, especially with darker skin, where irritation can make melasma darker.3457

What changes if you are pregnant?

During pregnancy, focus on sun protection and defer self directed pigment treatment until after delivery. Hydroquinone, tretinoin and tranexamic acid are not safe to use during pregnancy. Azelaic acid is an option to discuss with your clinician if treatment is needed. Pregnancy related pigmentation often fades over several months after birth, but it can persist or return in another pregnancy.2456

Will the patches disappear permanently?

Creams can fade melasma but cannot cure it permanently, which makes "erase" a rather ambitious verb. Some cases fade without treatment; others last for years. Improvement is usually slow, and sunlight can bring pigmentation back. If a nonprescription treatment has not given the results you want within three to six months, see a dermatologist rather than continuing indefinitely.35