Why does melasma occur?

What triggers melasma?

Sunlight stimulates pigment production, which explains why melasma tends to develop on exposed skin. Both ultraviolet light and visible light promote melanin production. Sun exposure can also darken existing patches and bring pigmentation back after treatment. Tanning beds and sunlamps expose skin to ultraviolet light and can trigger uneven pigmentation too.12

Hormones are another major factor. Rising estrogen and progesterone during pregnancy are thought to trigger melasma. Melasma is also associated with birth control pills and hormone replacement therapy during menopause. Hormonal contraceptive implants and intrauterine devices are implicated too. These associations do not mean every person using hormonal contraception will develop melasma.123

Possible medication triggers include antiseizure medicines and medicines that increase sensitivity to sunlight, including some antibiotics, retinoids and blood pressure medicines. Thyroid disease is also associated with melasma. Stress is a less settled explanation: some research suggests a role, but the link remains controversial. Discuss a suspected medication trigger with its prescriber before changing treatment.12

Why do some people get melasma and others do not?

Melasma is more common in women, often starting between ages 20 and 40, and in people with medium or darker skin tones. Having a blood relative with melasma also increases the risk. Men and people with lighter skin can develop it too. A trigger such as sunlight does not produce the same response in everyone.23

No food or drink is known to directly cause or cure melasma, which gives the grocery list one less job. Irritating skincare products can worsen melasma, and some scented soaps or cosmetics can cause a reaction when exposed to light.14

What is melasma on the face?

Facial melasma usually appears as flat brown patches on the cheeks, forehead, nose or upper lip, often in a matching pattern on both sides. Patches can also look bluish or gray. Melasma itself is harmless and usually does not hurt or itch, although the change in appearance can cause distress.34

Persistent facial darkening deserves a medical assessment rather than an automatic melasma diagnosis. Other conditions can resemble it. A dermatologist can examine the patches and use a Wood's lamp or dermatoscope to assess pigment depth; occasionally, a small skin sample is needed to clarify the diagnosis.35

Does melasma only occur on the face?

No. The face is the most common location, but melasma can also affect the neck, forearms, upper arms, shoulders and back. These are generally areas exposed to sunlight. Melasma often becomes darker in summer and lighter in winter.14

What is good for melasma on the face?

Sun protection is a foundation of treatment, not just prevention. It helps reduce further darkening and recurrence. A tinted sunscreen containing iron oxides is a useful choice for melasma; SPF 30 is the minimum advised, while SPF 50 or higher offers a higher protection option.135

1. 1Apply a broad spectrum sunscreen that protects against UVA and UVB before going outdoors.
2. 2Wear a wide brimmed hat and protective clothing, seek shade, and limit midday sun exposure.
3. 3Reapply sunscreen at least every two hours while in the sun.
4. 4Continue sun protection throughout the year, including winter, and avoid tanning beds and sunlamps.

What can I use for melasma?

There is no single best treatment for melasma, despite how convenient that would be for the skincare aisle. A dermatologist chooses treatment around pigment depth, skin tone and triggers. Pregnancy and possible medication triggers belong in that discussion before selecting treatment.5

Options include hydroquinone, which helps even skin tone, and a combination cream containing hydroquinone, tretinoin and a corticosteroid. Tretinoin is a retinoid; the corticosteroid reduces inflammation. Azelaic acid, kojic acid or vitamin C are other options a dermatologist can select, including gentler choices. Follow the prescribed schedule rather than using every option together.5

When using medication, sunscreen and camouflage makeup, the application order is medication first, sunscreen second and makeup last. Makeup can conceal patches while treatment takes effect. If a skincare product irritates your skin, stop using it and discuss the reaction, because irritation can worsen melasma.45

Chemical peels, lasers and other procedures require expert selection. They can worsen pigmentation, and some carry a substantial risk of relapse. Deeper pigment generally responds less well than pigment near the surface. For difficult cases, a dermatologist can consider tranexamic acid; a history of blood clots must be discussed before it is prescribed.145

How long does melasma take to fade?

Treatment usually takes 3 to 12 months to show results, and longstanding melasma can take longer. Melasma linked to pregnancy or hormone medicines often fades over several months after pregnancy ends or the medication is changed. It can also persist for years. Future pregnancies, restarting hormone medicines or sun exposure can bring the patches back, so continued sun protection matters even after fading.35