What does melasma on the face mean?

What does melasma look and feel like?

Melasma usually appears on both sides of the face, especially the cheeks, forehead, nose, chin and above the upper lip. Patches can be tan, brown, grayish brown or bluish gray, and sometimes resemble clusters of freckles. Typical melasma is flat and does not hurt or itch. Pain, itching or a raised area needs assessment rather than being assumed to be melasma.234

Why does melasma happen?

Sunlight and hormonal changes are common triggers. Ultraviolet and visible light encourage pigment production; pregnancy, birth control pills and hormone replacement therapy are also associated with melasma. Family history can contribute. Melasma affects anyone, but is more common in women and people with naturally brown skin or skin that tans easily. Having melasma does not, by itself, tell you which trigger caused it.124

Does every dark facial patch mean melasma?

No. Freckles, sun spots and dark marks left after inflammation can look similar. Marks that follow an injury or an inflamed spot can be postinflammatory hyperpigmentation, meaning extra pigment left after inflammation. A clinician examines the appearance, location and history of the discoloration. A Wood's lamp, a device using ultraviolet light, can help assess pigment; occasionally a biopsy is needed to distinguish another condition. Book an appointment if facial darkening does not go away.1245

What should you do about it?

1. 1Start with daily sun protection. Choose broad spectrum sunscreen with at least SPF 30; for melasma, an SPF 50 or higher sunscreen containing iron oxides is a useful choice. Apply before going outdoors and reapply at least every two hours while in the sun.
2. 2Add a wide brimmed hat and shade, especially around midday. Keep using sunscreen in winter and avoid tanning beds.
3. 3Arrange a diagnosis before choosing treatment. Discuss any hormonal medicines with your prescriber rather than changing them yourself.
4. 4Discuss treatment options if the discoloration bothers you. These include prescription creams, sometimes combining hydroquinone, tretinoin and a steroid. Other options include azelaic acid. Peels and lasers require expert care because they can worsen pigmentation.

Makeup can cover the discoloration while you decide about treatment, which gives it a useful job without promoting it to dermatology.1

What if you are pregnant?

Wait until after birth to start melasma treatment and focus on sun protection during pregnancy. Avoid hydroquinone and retinoids, including retinol and prescription tretinoin. A sunscreen containing zinc oxide, titanium dioxide or both is recommended during pregnancy to reduce irritation. Tell your obstetrician and dermatologist about prescription skincare and other medicines if you are pregnant or trying to conceive.36

Will melasma go away?

Melasma often fades over several months after pregnancy ends or a triggering hormonal medicine is stopped, but it can last for years. Treatment is slow, and pigment deeper in the skin generally responds less well than surface pigment. Discoloration can return with sun exposure. Creams can fade melasma rather than permanently cure it, so "erase" is a better word for the advertising department than the treatment plan.1234

Stop a skincare product that irritates your skin: irritation can worsen melasma, particularly in darker skin tones. If a treatment bought without a prescription has not delivered the results you want within three to six months, see a dermatologist rather than continuing indefinitely.3