What does melasma look like?

What should you look for?

• The patches are flat, not raised, and change the skin's colour rather than forming a bump.
• The outlines are irregular. Smaller patches can join together into a larger area.
• The colour is usually slightly darker than your natural skin tone. Several shades can appear together.
• Both cheeks can be affected, although the pigmentation can be more noticeable in one area than another.

Melasma patches can join into larger areas, so the condition does not always respect the boundaries of a neat little spot. In darker skin tones, the pigmentation can look bluish gray rather than simply brown. People with light skin can also develop melasma, including light brown patches on the forehead.4

Where does melasma appear?

The most common places are the cheeks, forehead, nose, chin and skin above the upper lip. Melasma can affect several of these areas at once, or be most obvious along the jawline or sides of the face. Less often, patches develop on the neck, forearms, upper arms or shoulders.124

Doctors describe patterns by location: a central facial pattern involves the forehead, cheeks, nose and upper lip; a cheek pattern involves the cheeks and nose; and a jawline pattern involves the jawline and chin. These names describe where the pigment sits, not separate conditions.12

Why are some patches brown and others gray?

Melasma involves excess melanin, the pigment that gives skin its colour. Pigment nearer the surface typically produces dark brown patches with clearer edges. Pigment deeper in the skin can look light brown or bluish, with blurrier edges. Mixed melasma, the most common type, combines brown and bluish shades. A dermatologist can examine the pigment using a Wood lamp, a special light used during skin examinations.13

Can another condition look like melasma?

Yes. Freckles, age spots, pigmentation left after inflammation and pigmentation caused by medicines can resemble melasma. Age spots are also flat and can be brown, tan or black. A photograph or colour match alone cannot reliably separate these conditions; a dermatologist usually diagnoses melasma by examining the skin and occasionally takes a small skin sample to exclude another cause.235

Have new or changing discoloration checked by a healthcare professional. Raised, rough, scaly, bleeding, itchy or painful areas need assessment rather than being assumed to be melasma. Melasma itself is not cancerous and does not turn into cancer, but some skin cancers can resemble it.135

Does its appearance change over time?

Melasma often darkens in summer and becomes less noticeable in winter. Sunlight and visible light can worsen the pigmentation. Pregnancy related melasma can fade a few months after delivery, but melasma can also persist for years or return after treatment stops. There is no fixed fading deadline and currently no cure, although treatment can improve its appearance.36

What can you do while getting it checked?

Use a tinted sunscreen containing iron oxides with SPF 30 or higher, alongside shade and a wide brimmed hat. Choose broad spectrum, water resistant protection and reapply every two hours outdoors, or sooner after swimming or sweating. Choose gentle, fragrance free skincare and stop using products that burn or sting, because irritation can darken the spots.6

Makeup can make melasma less noticeable, without requiring the concealer to moonlight as a treatment. If you want treatment, a dermatologist can tailor a plan; during pregnancy, avoid hydroquinone and retinoid creams.36