Understanding Melasma: Causes, Symptoms, and Treatment Options

Understanding Melasma: Causes, Symptoms, and Treatment Options

Melasma is a common skin condition that affects many people, especially women. The discoloration appears mostly on face, but it can occur on other sun-exposed areas, such as arms and neck. In this article, we will discuss the causes, symptoms and various treatment options available for melasma.

What is Melasma?

Definition and Overview

Melasma is a common, benign, and usually symmetric brownish condition affecting sun-exposed areas typically in women in their reproductive years. It appears in the form of patches or spots with irregular border and pigmentation. Melasma is not contagious, nor is it dangerous, but it can be persistent and emotionally distressing. The condition is more prevalent in people with darker skin types and is commonly referred to as “mask of pregnancy”.

Causes of Melasma

The exact cause of Melasma is not yet known. However, it is believed to be caused by a combination of genetic, hormonal, and environmental factors. Hormonal changes during pregnancy, menopause, or while taking birth control pills can trigger Melasma. Exposure to sunlight and heat can also worsen the condition.

Common Areas Affected by Melasma

The most common areas of the body that can be affected by Melasma include the face, neck, forearms, and temples. Melasma can also affect other areas of the body, such as the chest, back, and shoulders.

Symptoms of Melasma

The most common symptom of Melasma is the appearance of brownish patches or spots on the skin. The patches may be flat or raised and have an irregular shape. They may also be itchy or tender to the touch. In some cases, Melasma can cause emotional distress, especially if the patches appear on the face.

Treatment of Melasma

There is no cure for Melasma, but there are several treatment options available to manage the condition. Topical creams containing hydroquinone, tretinoin, or corticosteroids can help lighten the patches. Chemical peels, microdermabrasion, and laser therapy can also be effective in reducing the appearance of Melasma. It is important to use sunscreen with a high SPF to protect the skin from further damage.

Melasma vs. Other Skin Conditions

It is essential to differentiate Melasma from other skin conditions that can mimic similar pigmentation-like Acne vulgaris, and Post-Inflammatory Hyperpigmentation. The diagnosis can be challenging and require a multi-disciplinary approach between dermatologists, primary care providers, and other specialists alike.

Prevention of Melasma

Preventing Melasma involves protecting the skin from the sun’s harmful UV rays. Wearing protective clothing, such as hats and long-sleeved shirts, and using sunscreen with a high SPF can help prevent Melasma from developing or worsening. Avoiding excessive exposure to heat and sunlight can also help prevent Melasma.

Causes of Melasma

Melasma is a common skin condition that causes dark, discolored patches on the face, particularly on the cheeks, forehead, nose, and chin. While the exact cause of melasma is unknown, several factors have been identified that can contribute to its development.

Genetic Factors

Research has shown that genetics may play a role in melasma development. Some individuals may be more prone to developing this condition due to their genetic makeup. In fact, studies have identified several genetic factors that make certain individuals more susceptible to this skin condition.

However, it’s important to note that just because someone has a genetic predisposition to melasma does not necessarily mean that they will develop it. Other factors, such as hormonal changes and sun exposure, can also contribute to its development.

Hormonal Influences

Female sex hormones, estrogen and progesterone, play a significant role in melasma development. Women are 9 times more likely than men to get melasma. It is common during pregnancy, taking birth control pills, and undergoing hormone replacement therapy.

During pregnancy, melasma is often referred to as the “mask of pregnancy” because it commonly appears on the face. This is due to the increased levels of estrogen and progesterone in the body. Similarly, women who take birth control pills or undergo hormone replacement therapy may also experience melasma due to the hormonal changes that occur.

It’s important to note that melasma may subside after discontinuing hormonal replacements, or it may re-appear with sun exposure or irritation of the skin.

Sun Exposure and Ultraviolet Radiation

UV radiation, especially UVA, triggers skin damage that worsens Melasma’s appearance. Hyperpigmentation worsens through cumulative sun damage of unprotected skin. Good sun protection, including wearing hats and sunscreen, can prevent further damage to the skin and may improve Melasma’s appearance.

Sun exposure is a major contributing factor to melasma. UV radiation from the sun can trigger the production of melanin, the pigment that gives skin its color. When melanin production is increased, it can lead to the development of dark patches on the skin.

Protecting your skin from the sun is important in preventing melasma. This includes wearing a hat, using a broad-spectrum sunscreen with an SPF of 30 or higher, and avoiding prolonged sun exposure, especially during peak hours.

Skin Irritation and Inflammation

Some skin care products and cosmetics can irritate the skin and cause inflammation leading to Melasma’s progression. Skin irritation and inflammation can worsen Melasma through the activation of inflammatory mediators, such as interleukins and tumor necrosis factor-alpha.

It’s important to be mindful of the products you use on your skin, especially if you have melasma. Avoid using harsh or abrasive products that can irritate the skin. Instead, opt for gentle, non-irritating products that are specifically formulated for sensitive skin.

In conclusion, while the exact cause of melasma is unknown, several factors have been identified that can contribute to its development. By understanding these factors and taking steps to prevent them, you can help manage your melasma and maintain healthy, beautiful skin.

Symptoms and Diagnosis

Identifying Melasma Symptoms

Melasma is a common skin condition that affects many individuals, primarily women. It appears as tan or brown-grayish patches on the face or other sun-exposed areas. These patches can be small or cover a large area and usually appear symmetrical with an indistinct border. Melasma is often referred to as the “mask of pregnancy” because it frequently appears during or after pregnancy, or after taking birth control pills or other hormone therapies.

In addition to hormonal changes, sun exposure is also a significant factor in the development and worsening of melasma. The patches may worsen with sun exposure, so it is essential to use sunscreen and protective clothing when going outside.

How Melasma is Diagnosed

If you suspect that you have melasma, it is crucial to see a dermatologist for a proper diagnosis. The doctor can diagnose melasma by physical examination and taking a person’s medical history. It is essential to distinguish melasma from other skin pigmentation disorders, such as post-inflammatory hyperpigmentation or even skin cancers. The diagnosis process may also include a skin biopsy to rule out other skin conditions.

Melasma Severity Scale

The Melasma Severity Scale is a tool used by dermatologists to assess the severity of melasma based on the distribution, color, and intensity. It helps to determine appropriate treatment options and to evaluate the response to therapies. The scale ranges from mild to severe, with mild cases having only a few small patches and severe cases covering a large area of the face and other sun-exposed areas.

If you are diagnosed with melasma, your dermatologist will work with you to determine the best treatment plan based on the severity of your condition. Treatment options may include topical creams, chemical peels, or laser therapy. It is important to follow your dermatologist’s instructions and continue to protect your skin from the sun to prevent further damage and the worsening of your melasma.

Treatment Options for Melasma

Topical Treatments


Hydroquinone is the gold standard topical melasma treatment. It acts by inhibiting the conversion of melanin precursors to melanin. It is available over-the-counter or by prescription in various strengths, ranging from 2% to 4%. Side effects are mild and include dryness, burning, and itching.


Tretinoin, a derivative of vitamin A, increases skin cell turnover and reduces the amount of melanin in the skin. It is commonly used in combination with hydroquinone to improve melasma’s appearance. Its side effects are skin irritation, dryness, and peeling.


Corticosteroids are anti-inflammatory compounds that can reduce Melasma inflammation and hyperpigmentation. They often used in a dual therapy with hydroquinone and tretinoin, making this combination of topical treatments effective in treating patients with Melasma. Side effects may include skin atrophy, striae, and rosacea development. Therefore, it is essential to continue with strict sun protection during and after topical treatment plans.

Chemical Peels

Chemical peels can improve skin texture by removing the outermost epidermal layer of skin. This can be done with various chemical agents, such as glycolic acid, lactic acid, or trichloroacetic acid. Chemical peels can reduce Melasma pigmentation, but they may need to be repeated to sustain results. Side effects include temporary erythema, peeling, and crusting.

Laser and Light Therapies

Intense pulsed light or fractional ablative lasers can improve melasma by selectively destroying unwanted melanocytes in the skin. It may take several treatments to see the desired results, and the treatment may not be effective in all patients. Side effects may include immediate erythema, crusting, and post-inflammatory hyperpigmentation.

Microneedling and Microdermabrasion

Microneedling and microdermabrasion are minimally invasive procedures that improve Melasma by increasing the skin’s collagen production and reducing hyperpigmentation. These treatments have mild side effects, including erythema, swelling and skin irritation. It may take multiple office visits to see the desired results.


To conclude, Melasma is a common pigment disorder that often affects women during their reproductive years, although it can occur in men and women of all ages. Its causes are multifactorial, and treatment options vary from topical medications to in-office procedures. It is essential to maintain strict sun protection and skincare regimes even after treatment to prevent Melasma relapse. Consultation with a dermatologist is required to determine the appropriate diagnosis and best course of treatment.

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