What causes melasma on the face?

Why does melasma appear on the face?

Sunlight stimulates melanin production, which helps explain why melasma commonly affects exposed areas such as the cheeks, forehead, nose and upper lip. Ultraviolet light can trigger melasma and make existing patches darker. Visible light also contributes to pigmentation, particularly in darker skin tones. Melasma often becomes more noticeable in summer and improves in winter. Tanning beds and sunlamps can also trigger it.2345

There is no evidence that blue light from personal electronic devices affects the skin, so your phone does not need a speaking role in this particular problem.5

What makes someone more likely to develop melasma?

• Hormonal changes: Pregnancy raises estrogen and progesterone levels, which are thought to trigger melasma. Hormonal birth control can also contribute.
• Family history: Having a blood relative with melasma increases your risk, although it does not mean you will develop it.
• Age and skin tone: Melasma is more common in women aged 20 to 40 and people with medium or dark skin tones. Men and people with lighter skin can develop it too.
• Medicines: Some antiseizure medicines and medicines that increase sensitivity to sunlight can trigger melasma. Examples include some antibiotics, retinoids and blood pressure medicines.
• Thyroid problems: Thyroid disease is associated with melasma. It is one possible contributor, not an explanation for every case.

Does HRT cause melasma?

Hormone replacement therapy, or HRT, can contribute to melasma. The condition is associated with estrogen and progesterone and occurs in some women taking HRT during menopause. If patches appeared after starting hormone treatment, discuss the timing with your prescriber rather than stopping prescribed medicine yourself. Melasma often fades over several months after a hormone trigger is removed, but can return if the medicine is used again.45

Can skincare, stress or food cause it?

Some scented soaps, toiletries and cosmetics can cause a phototoxic reaction, meaning a skin reaction triggered by light, that contributes to melasma. Irritating skincare can also make existing melasma worse. Stop using products that irritate your skin and choose gentle, fragrance free formulas.567

Stress is a possible trigger, but the connection remains controversial. No foods or drinks are known to directly cause, cure or worsen melasma, so a menu is not a melasma treatment plan.36

What can you do about the triggers?

Use a broad spectrum SPF 50 or higher sunscreen every morning, including in winter. Choose a tinted formula containing iron oxides for added protection against visible light. Apply plenty 15 to 30 minutes before going outdoors, and reapply every two hours outdoors and after swimming or towel drying. Add a wide brimmed hat and shade rather than relying on sunscreen alone. Avoid tanning beds.1457

Pregnancy related melasma can fade a few months after delivery, but some cases last for years. Treatment can improve the patches, although melasma often returns after treatment stops or with renewed sun exposure. During pregnancy, avoid hydroquinone and retinoid creams.357

When should you get facial pigmentation checked?

Melasma usually causes flat brown or greyish patches on both sides of the face without itching or pain. Melasma itself is not cancerous, but other conditions can look similar. See a clinician for facial darkening that does not go away, or a patch that changes, hurts or itches. A skin examination can help distinguish melasma from other causes of pigmentation.1456