Melasma: What Is It, Causes, And Treatment Options


by Ravi Teja Tadimalla

Melasma is a skin pigmentation disorder. It is characterized by brown or gray skin patches. While the condition itself is not fatal, it could have a negative psychological impact on some individuals.

But not all cases of melasma are permanent. With the right treatment methods and remedies, the condition could be treated. Here, we further elaborate on melasma, its causes, treatment options, and the preventive care you can undertake.

What Is Melasma?

Melasma is a skin disorder that causes hyperpigmentation on the sun-exposed areas of your face and body. It leaves brown or blueish gray patches on your face and body and is especially common among individuals with brown skin living in tropical latitudes. The skin condition also affects mostly women.

Melasma is also called chloasma or mask of pregnancy when developed during pregnancy. Although it is painless and benign, it can hamper your social life by making you self-conscious.

Only a licensed medical practitioner or a dermatologist can examine your skin and diagnose the skin condition. We will now look at some symptoms of this skin disorder.

Symptoms Of Melasma

The primary symptom of melasma is the appearance of brown, gray, or discolored patches on your skin. These patches have a different color than your skin tone and usually develop on the following areas:

  • Cheeks
  • Upper lip
  • Forehead
  • Chin
  • Nose

In some cases, people may also develop discolored patches on their neck, arms, and shoulders. Sometimes the patches can become inflamed and appear red.

Types Of Melasma

Based on the type of patches, amount of melanin, and color, melasma can be classified as any of the following three types:

1. Epidermal Melasma

Epidermal melasma is visible clearly under a wood lamp since the patches have well-defined borders and are in dark brown color. This type shows a good response to treatments.

2. Dermal Melasma

Dermal melasma consists of patches with irregular and poorly defined borders or discoloration. Usually, the patches have a light brown or blue-gray hue and show no noticeable difference under a wood lamp. This type is usually harder to treat.

3. Mixed Melasma

A mixed type of melasma is a combination of the other two types. It is seen more commonly and has a mix of dark brown, light brown, and blueish gray patches. This type of melasma could respond to treatment relatively slowly.

The exact causes of melasma could differ from person to person. In the following section, we have listed the major reasons.

Causes Of Melasma

Melasma on the face is largely attributed to sun damage or pregnancy. However, various other factors can cause brown patches on the face and body.

1. Genetic Predisposition

Some people are more likely to have melasma than others due to a genetic predisposition (1). This holds true for individuals with brown skin who live in the tropics and experience more sun exposure. About half of the people diagnosed with melasma reported a family history of the skin condition (2).

2. Pregnancy

Pregnancy melasma is very common in females. This could be attributed to hormonal changes. It is often called chloasma or the mask of pregnancy (3).

3. Hormonal Issues

Other hormonal issues or imbalances may also lead to melasma. Progesterone plays a primary role in the development of this skin condition (2). Birth control pills or hormone replacement medicines may increase the levels of progesterone in your body.

4. Certain Medications Or Scented Products

Consuming certain anti-seizure medications, oral contraceptives, certain steroids, photosensitizing drugs, and phototoxic drugs can also trigger melasma (2). Skincare products that irritate your skin may worsen the dark patches on the face.

5. Sun Exposure

Sun exposure can lead to melasma on the arms, neck, and face. The UV rays from the sun can stimulate melanocytes and also cause faded melasma to return (3). Even sunscreens can fail to block longer wavelengths of UV-A radiation that causes excessive production of melanin (2).

We now understand how melasma is diagnosed by medical professionals.

How Is Melasma Diagnosed?

Since melasma causes visible patches on the face and other parts of the body, it is fairly easy to diagnose. However, a dermatologist may carry out a few tests to rule out any other skin conditions and definitively determine the extent of pigmentation due to melasma.

A wood lamp is held over your patches to determine any other fungal or bacterial infection on the patches and to understand the extent of melasma. In some cases, a skin biopsy may also be carried out to differentiate melasma from other skin infections.

Melasma treatment involves the use of topical creams or oral pills that lighten the brown patches. Know more about these treatment options in the next section.

What Are The Best Treatment Options For Melasma?

Although there is no definitive cure, your doctor can prescribe you one of the many treatments used to combat melasma on your forehead, face, neck, and body.

Hydroquinone

Your dermatologist may prescribe a topical hydroquinone cream as the first line of treatment for melasma. This cream can lighten the brownish patches on your skin. It may be used in the form of a cream, gel, or lotion and is mostly safe for topical application (3).

Methimazole

For hydroquinone-resistant melasma, a treatment with methimazole is prescribed. It can be used as a topical anti-thyroid cream (4).

Hydroquinone, Tretinoin, And Fluocinolone Acetonide

A triple combination cream containing (hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01%) is also used to treat melasma. The combination works to lighten the patches and get a more even skin tone (2).

Chemical Skin Peels

Skin peels using glycolic- or salicylic acid-based creams can help treat melasma to some extent. These peels will remove the top layer of the skin and reduce the dark hue of the patches (2).

Other Procedures

For more stubborn patches, other procedures like dermabrasion, microdermabrasion, and laser treatment could be suggested. These procedures have varied results for different people and must be performed only by a dermatologist (3).
Note that melasma is stubborn and requires proper care after treatment. The following natural methods could help reduce the risk of melasma.

How To Treat Melasma Naturally

Melasma treatments are usually long and take time to completely heal your skin. While chloasma may disappear after a few months post-pregnancy, melasma caused due to other factors may need extended treatment.

Here are some natural remedies for melasma you can try today. However, these are not a replacement for medical treatments and must only be followed with normal dermatological treatments.

1. Use Natural Antioxidants

Vitamins C and E are known to help in the treatment of chloasma (5).

You can either use a serum containing these vitamins or a homemade lemon juice, vitamin E (in a capsule form), and water mix to soothe the skin damage. The vitamin C in lemon juice can inhibit the tyrosinase enzyme and control melanin production (6).

2. Keep Your Skin Moisturized

Skin contains a natural fat barrier that protects it from the harsh sun. To keep the barrier healthy, you should moisturize your skin daily. Follow a regular cleansing and moisturizing routine to retain your skin’s natural moisture.

3. Utilize Alpha-Hydroxy Acids

Apply alpha-hydroxy acids such as lactic, malic, and glycolic acids to your skin. These acids can improve skin glow by reducing tyrosinase activity and may provide a natural relief from melasma (7).

Mix natural sources of alpha-hydroxy acids like milk, yogurt, cream, or Indian gooseberry with equal amounts of rosewater and lemon juice. Apply the mixture to your skin and rinse after 15 to 20 minutes.

Can Melasma Be Prevented?

Unfortunately, melasma cannot be prevented. Melasma due to genetics cannot be altered or changed. Chloasma cannot be prevented since pregnancy tends to create a natural influx of hormones.

Nevertheless, keeping your skin well protected will reduce your chances of developing melasma, more so if you have a family history of the disorder. As for chloasma, it may fade away on its own in a few months. Hence, it is not a very critical condition to worry about.

Here are certain ways to mitigate the effects of melasma on your face:

  • A good diet rich in greens and micronutrients will improve your skin health and make it more resistant to sun damage.
  • Use skin care products that do not irritate your skin.
  • Use sunscreen daily. It is recommended to choose a cream with SPF between 30 to 50. Reapply it every 2 hours if you stay out in the sun for longer durations.
  • Use makeup to cover dark spots or melasma. Choose a high coverage foundation or concealer to hide the melasma patches on your face and body.
  • Commit to a skincare regimen to maintain an even skin tone. If you are not diligent in protecting your skin from the sun, the patches may return post-treatment.

Closing Thoughts

Melasma is an otherwise harmless skin condition without any major symptoms. However, it can bother the affected person and result in a feeling of self-consciousness.

The great news is that you can lighten the patches with proper treatment and care. Melasma typically requires a few months to clear up, so it is advisable to follow the treatment religiously and be patient about the results.

Expert’s Answers For Readers’ Questions

Does laser treatment work for melasma? Is the treatment safe if you are pregnant?

Laser treatment for melasma produces different results for each individual. These results are usually short-lived. Pregnant women must wait until the end of their term to get any laser treatment done.

Which foods can make melasma worse?

Anecdotal evidence suggests that people with melasma should avoid foods that contain estrogen, such as soy milk, tofu, and chickpeas. These foods are believed to aggravate melasma.

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Ravi Teja Tadimalla

Ravi Teja Tadimalla is an editor and a published author. He graduated from SRM University, Chennai, and has been in the digital media field for over six years. He has a Professional Certificate in Food, Nutrition & Research from Wageningen University. He considers himself a sculptor born to chip away at content and reveal its dormant splendor. He started his career as a research writer, primarily focusing on health and wellness, and has over 250 articles to his credit. Ravi believes in the great possibilities of abundant health with natural foods and organic supplements. Reading and theater are his other interests.
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