What is melasma?

Melasma, sometimes referred to as “the mask of pregnancy,” is a common skin pigmentation condition characterized by ill-defined brown or gray patches on the skin, most commonly on the face. Melasma may also develop on other parts of the body, especially areas exposed to sunlight such as the forearms, neck and shoulders.

Women with darker complexions or who are pregnant are at greater risk of developing melasma. Only 10% of melasma cases occur in men.

What causes melasma?

Scientists do not know the exact cause of melasma, although it may be caused by a malfunction of melanocytes, which are the color-forming cells in the skin, triggering the production of too much color. People with darker skin tones are more likely to develop melasma, mainly because they have more melanocytes than individuals with lighter skin.

Hormonal changes during pregnancy or history of birth control pills may trigger melasma. Other known factors include intense sun exposure and the use of skin care products that cause irritation.

Genetics may also play a role in melasma, as scientists have noted that people whose immediate family have experienced melasma are more likely to develop it themselves.

How dermatologists diagnose melasma

A physical examination evaluating the dark patches of skin is usually all that’s required for your dermatologist to diagnose melasma. In some cases your dermatologist my darken the exam room and use a Wood’s lamp, also commonly known as a blacklight, to illuminate your skin. Superficial pigmentation changes or the presence of bacteria or fungi will cause that area of your skin to enhance under the light. In rare cases your dermatologist may need to remove a small piece of skin (known as a biopsy) for further testing to rule out other conditions that have a similar appearance.

How dermatologists treat melasma

In women, melasma may fade on its own after a pregnancy or discontinuation of birth control pills.

In other cases, your dermatologist may recommend a hydroquinone containing topical cream as a first step in treatment. This medicine is available both over-the-counter and in stronger formulations that require a prescription. Hydroquinone works by inhibiting melanin production, thereby lightening the skin. It is important to practice regular sun protection habits during and after treatment to maintain the results.

For persistent or stubborn melasma, your dermatologist may prescribe a stronger cream that combines three ingredients: hydroquinone, tretinoin and a mild corticosteroid. This combination is used for a given period of time followed by maintenance treatment.

If topical medicine does not improve the condition, your dermatologist may discuss with you procedures including chemical peels, light-based procedures, or laser treatments.

For the best results of melasma treatment, broad spectrum, water resistant sun protection, preferably with a mineral based sunscreen containing zinc or titanium dioxide and SPF 30 or higher, should be used regularly along with general reduction of exposure to the sun’s rays.

If you have skin lesions that are concerning for melasma, click here to schedule an appointment with our board-certified dermatologists or walk into Walk-in Dermatology at your convenience for your evaluation.