What Is Melasma?
Melasma is a common skin condition that causes brown to gray-brown patches, mostly on sun-exposed areas of the face. The patches are flat, usually appear on both sides of the face in a matching pattern, and have irregular borders. Melasma is harmless and does not turn into skin cancer.
Melasma is linked to sunlight, the hormones estrogen and progesterone, and inherited tendency. It most often affects young women with brown skin tones, but anyone can get it. It is so common during pregnancy that it is sometimes called the "mask of pregnancy." Melasma is long-lasting and tends to come back, so treatment aims to control it rather than cure it.
Melasma at a Glance
| Also called | Chloasma, mask of pregnancy |
|---|---|
| Cause | Light exposure (ultraviolet and visible light), hormones and genetic tendency |
| Where it appears | Cheeks, forehead, nose, upper lip and jawline. Less often the forearms or neck. |
| Who gets it | Mostly women. About 90% of people with melasma are women, and it usually starts between ages 20 and 40. |
| Is it serious? | No. It is harmless and not cancerous, but it can affect self-esteem. |
| Diagnosis | A skin exam. Sometimes a Wood's lamp, dermoscopy or a skin biopsy. |
| Treatment | Daily sun protection, prescription lightening creams, oral tranexamic acid for some patients, and chemical peels or lasers |
| ICD-10 code | L81.1 (chloasma) |
What Does Melasma Look Like?
The only symptom of melasma is a change in skin color. Common features include:
- Color: light brown, dark brown or blue-gray patches, or freckle-like spots
- Pattern: patches that are often symmetrical, appearing on both sides of the face
- Location: the center of the face (forehead, cheeks, nose and upper lip) is the most common pattern. Melasma can also affect the cheeks and nose only, or the jawline.
- Texture: flat, not scaly and not thickened
- Feel: no pain or itching
- Timing: it appears slowly over weeks or months. It often gets darker in summer and lighter in winter.
Melasma away from the face is less common. When it occurs, it usually affects chronically sun-exposed areas such as the forearms and neck, and it is seen more often after menopause.
What Causes Melasma?
Cells in the skin called melanocytes make a dark pigment called melanin. Light, heat, ultraviolet (UV) radiation and hormones can make these cells produce more melanin. In melasma, changes in blood vessels and the deeper skin layer also seem to keep the pigment active, which may explain why it is hard to clear.
Common triggers and risk factors include:
- Sunlight: light exposure is the most consistent trigger you can control. Both UV light and visible light play a role. Blue light matters especially in darker skin.
- Pregnancy: higher estrogen and progesterone levels are thought to play a role.
- Hormone medicines: birth control pills and hormone replacement therapy during menopause
- Family history: about 33% to 50% of people with melasma report a relative who has it.
- Skin tone: people with brown skin or skin that tans well are more likely to get melasma than people with fair skin.
- Skin irritation: irritating skin care products, some scented soaps and waxing can make melasma worse.
- Certain medicines: some antiseizure drugs and drugs that make skin more sensitive to sunlight
Is Melasma Serious?
Melasma is not dangerous to your physical health, and it does not become cancer. Its main effect is emotional. Because it shows on the face and lasts a long time, it can cause distress, embarrassment and lower self-esteem.
Melasma linked to pregnancy or hormone medicines often fades over several months after the pregnancy ends or the medicine is stopped. Without ongoing sun protection and maintenance treatment, improvement is often temporary.
How Is Melasma Diagnosed?
A clinician usually diagnoses melasma by looking at your skin and asking about when it started, sun exposure, pregnancy, hormone use and family history. Other tools may help:
- Wood's lamp: an ultraviolet light once used to judge how deep the pigment is. Its findings are inconsistent, especially in darker skin, so it is used less often today.
- Dermoscopy: a magnified look at the skin that shows pigment patterns and small blood vessels
- Skin biopsy: a small skin sample, used when another condition is possible. Some skin cancers can look like melasma.
Routine lab tests are not needed in typical cases of melasma.
How Is Melasma Treated?
Melasma care has three parts: avoiding triggers (especially light), lightening the patches, and long-term maintenance to prevent relapse. Combined treatments generally work better than one alone.
Sun Protection
Daily sun protection is essential and should continue indefinitely. Tinted sunscreens that contain iron oxides are preferred, because these pigments help block visible light.
Prescription Creams
- Hydroquinone: a highly effective lightening agent, used in supervised, limited-duration courses
- Triple-combination cream: fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05%. A Cochrane review found it was more effective at lightening melasma than hydroquinone alone.
- Other agents: azelaic acid, cysteamine, kojic acid and topical retinoids, used as alternatives or for maintenance
The most common side effects are mild and short-lived, such as irritation, itching, burning and stinging. Irritation matters, because inflamed skin can make the pigment darker.
Oral Tranexamic Acid
Tranexamic acid, taken by mouth, may be added for moderate-to-severe melasma or melasma that hasn't responded to other treatment. In a placebo-controlled study of 44 patients with moderate-to-severe melasma, the tranexamic acid group had a 49% reduction in melasma severity scores at 3 months, compared with 18% in the placebo group. Because it affects blood clotting, clinicians screen for clot risk first. A history of blood clots, current or planned pregnancy, and estrogen-containing birth control are key concerns.
Procedures
Chemical peels may help, and lasers may be used if melasma is severe. Microneedling and radiofrequency are also used as a main or add-on treatment. Peels and lasers can cause darkening after treatment and scarring, so they should be done by clinicians experienced in treating melasma.
Can You Prevent Melasma?
Daily sun protection can lower your risk and help prevent relapses:
- Use a broad-spectrum sunscreen with SPF 30 or higher every day, year-round, including winter.
- Reapply at least every 2 hours while in the sun.
- Consider a tinted sunscreen with iron oxides for added visible-light protection.
- Wear a hat and long sleeves, and avoid midday sun.
- Avoid tanning beds and sun lamps.
- Choose gentle skin care, and avoid products that irritate your skin.
When Should You See a Clinician About Melasma?
See a clinician if you notice:
- Darkening of your face that does not go away
- A dark patch that is raised or scaly, which may be a different condition
- Melasma that persists after pregnancy or after stopping hormone medicines
- Melasma during pregnancy, so you can choose treatments that are safe while pregnant
Melasma vs. Other Dark Spots
| What it is | Look and location | Who gets it | |
|---|---|---|---|
| Melasma | Long-lasting pigment condition driven by light, hormones and genes | Larger, symmetrical brown to gray-brown patches on the cheeks, forehead, nose and upper lip | Mostly women. Usually starts between ages 20 and 40. |
| Post-inflammatory hyperpigmentation | Darkening left behind after an inflammatory skin condition | Dark areas where the skin was inflamed | More frequent and more severe in darker skin |
| Liver spots (age spots) | Flat sun-related spots in older skin | Smaller, light brown to black spots on the hands, face, forearms and shoulders | Very common after age 50 |
Post-inflammatory hyperpigmentation is treated by first managing the condition that caused the inflammation. Liver spots usually need no treatment.
Melasma Evaluation at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a provider can examine dark patches on your skin and review your sun exposure, hormone use and medical history. Based on that evaluation, your provider will recommend whether treatment can be done at GENEVA or whether you should see a dermatologist.
You can ask about pigment concerns through our skin pigmentation treatment page or during a primary care visit. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
- Post-Inflammatory Hyperpigmentation (PIH)
- Rosacea
- Estrogen
- Medical-grade skincare
- Retinoid therapy
- TCA peel
- VI Peel Treatment | Benefits, Results and What to Expect
Melasma FAQs
Is melasma serious?
No, melasma is not serious for your physical health. Melasma is harmless, does not itch or hurt, and does not turn into cancer. Its main burden is emotional: studies link it to distress, embarrassment and reduced self-esteem, and severity doesn't always match how much it bothers someone. One caution is that some skin cancers can look like melasma. Have a clinician confirm the diagnosis if a patch is raised or scaly.
What triggers melasma?
Melasma is triggered mainly by light and hormones, and an inherited tendency also plays a role. Light exposure, including ultraviolet and visible light, is the most consistent trigger you can control, and blue light may matter most in darker skin. Pregnancy, birth control pills and hormone replacement therapy are common hormonal triggers. About 33% to 50% of people with melasma report a relative who has it. Irritating skin care products, some scented soaps and waxing can also make it worse, so gentle skin care helps.
Does melasma go away?
Melasma sometimes fades on its own, but there is no definitive cure and it often comes back. Melasma tied to pregnancy or hormone medicines often fades over several months after the pregnancy ends or the medicine is stopped. For birth control, fading typically takes about three months or more. Melasma can return with another pregnancy, hormone use or sun exposure. Ongoing sun protection and maintenance treatment give the best chance of keeping it under control.
How long does melasma treatment take?
Melasma treatment usually takes months, and maintenance continues long term. Hydroquinone cream is typically applied to the patches at night for two to four months. In one placebo-controlled study, oral tranexamic acid reduced severity scores by 49% after 3 months, versus 18% with placebo. Three months after stopping, the improvement had shrunk to 26%, compared with 19% for placebo. Melasma can be slow to respond, so keep using sunscreen daily even after it fades.
What is the difference between melasma and sun spots?
Melasma forms larger, symmetrical patches, while sun spots (liver spots) are smaller spots. Melasma usually starts between ages 20 and 40 and is linked to hormones as well as light. Liver spots are flat, light brown to black, and very common after age 50 on sun-exposed skin such as the backs of the hands, face and forearms. Liver spots usually need no treatment. Because both can resemble other conditions, a clinician should examine any new or changing spot.
How can I prevent melasma from coming back?
Daily sun protection is the most important way to keep melasma from coming back. Use a broad-spectrum sunscreen with SPF 30 or higher every day, year-round, and reapply at least every 2 hours in the sun. A tinted sunscreen with iron oxides adds protection against visible light. Wear a hat, avoid midday sun and skip tanning beds. Intensive sunscreen use can reduce relapses, yet most people with melasma don't follow sun protection advice closely enough.
Can melasma be treated during pregnancy?
Melasma during pregnancy can be managed, but some treatments must wait. Melasma often fades within about three months after pregnancy, so the first step is keeping it from getting worse with sun protection. Azelaic acid is considered safe to use during pregnancy. Tretinoin should not be used during pregnancy, and oral tranexamic acid is not recommended for people who are pregnant or planning pregnancy. Ask your clinician before using any lightening cream or pill while you are pregnant.
Can a primary care provider diagnose melasma?
Yes, a primary care provider can often diagnose melasma by examining your skin. Melasma is mainly a clinical diagnosis, and routine lab tests are not needed in typical cases. A Wood's lamp, dermoscopy or a skin biopsy may be used if the diagnosis is unclear. At GENEVA, your provider evaluates the dark patches and then recommends treatment at GENEVA or a referral to a dermatologist, depending on the type and severity of your melasma.