Melasma: The forehead is commonplace for melasma to appear.
Melasma: Overview
Melasma (muh-LAZ-muh) is a common skin problem. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck.
One of the most common treatments for melasma is sun protection. This means wearing sunscreen every day and reapplying the sunscreen every 2 hours. Dermatologists also recommend wearing a wide-brimmed hat when you are outside. Sunscreen alone may not give you the protection you need.
Women are far more likely than men to get melasma. It is so common during pregnancy that some people call it the mask of pregnancy. Hormones seem to trigger melasma.
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Melasma: Blotchy patches of darker color often appear on the cheeks. The woman on the right developed the brown patches while pregnant.
Melasma: Signs and symptoms
Common signs (what you see) of melasma are brown or gray-brown patches on the face. These patches most commonly appear on the:
Cheeks.
Forehead.
Bridge of the nose.
Above the upper lip.
Chin.
Some people get patches on their forearms or neck. This is less common.
Melasma does not cause any symptoms (what people feel). But many people dislike the way melasma makes their skin look.
Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Melasma: Who gets and causes
Who gets melasma?
Melasma appears on women’s skin much more often than men’s skin. Just 10% of people who get melasma are men.
People with darker skin, such as those of Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent are more likely to get melasma. People who have a blood relative who had melasma also are much more likely to get melasma.
What causes melasma?
What causes melasma is not yet clear. It likely occurs when the color-making cells in the skin (melanocytes) produce too much color. People with skin of color are more prone to melasma because they have more active melanocytes than those with light skin.
Common melasma triggers (what starts it) include:
Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. In fact, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma often is worse in summer. It also is the main reason why many people with melasma get it again and again.
A change in hormones: Pregnant women often get melasma. When melasma appears in pregnant women, it is called chloasma, or the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma.
Cosmetics: Skin care products that irritate the skin may worsen melasma.
Melasma: Diagnosis and treatment
How do dermatologists diagnose melasma?
Dermatologists can diagnose most patients by looking at their skin. To see how deeply the melasma penetrates the skin, your dermatologist may look at your skin under a device called a Wood’s light.
Sometimes melasma can look like another skin condition. To rule out another skin condition, your dermatologist may need to remove a small bit of skin. This procedure is called a skin biopsy. A dermatologist can safely and quickly perform a skin biopsy during an office visit.
How do dermatologists treat melasma?
Melasma can fade on its own. This usually happens when a trigger, such as a pregnancy or birth control pills, causes the melasma. When a woman delivers her baby or stops taking the birth control pills, melasma can fade.
However, some people have melasma for years, or even a lifetime. If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available. These include:
Hydroquinone: This medication is a common first treatment for melasma. It is applied to the skin and works to even out your skin tone. Hydroquinone is no longer available without a prescription. If hydroquinone is a good fit for you, your dermatologist can prescribe it.
Tretinoin and corticosteroids: To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains three medicines (hydroquinone, tretinoin, and a corticosteroid) in one cream. This is often called a triple cream.
Other topical (applied to the skin) medicines: Your dermatologist may prescribe azelaic acid or kojic acid to help reduce melasma.
Procedures: If medicine you apply to your skin does not get rid of your melasma, a procedure may succeed. Procedures for melasma include a chemical peel, microdermabrasion, dermabrasion, laser treatment, or a light-based procedure. Only a dermatologist should perform these procedures.
New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type.
Ask your dermatologist about possible side effects (health problems that can result from the treatment).
If you notice any of the following after getting treatment for melasma, be sure to call your dermatologist:
Skin irritation
Darkening of the skin
Other problems
Outcome
Under a dermatologist’s care, many people with melasma have a good outcome. Melasma can be stubborn, though. It may take a few months of treatment to see improvement. It is important to follow your dermatologist’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects.
After your melasma clears, you may need to keep treating your skin. Your dermatologist may call this maintenance therapy. Maintenance therapy can prevent melasma from returning.
You can help prevent your melasma from returning by wearing sunscreen and a wide-brimmed hat every day.
All content solely developed by the American Academy of Dermatology
Melasma: Tips for managing
Melasma is a common skin problem that causes brown to gray-brown patches on the face. Although the exact causes of melasma are unclear, common triggers include sun exposure, pregnancy, birth control pills, and cosmetics.
If you have melasma, dermatologists recommend the following tips for achieving a more even skin tone:
Wear sunscreen daily: One of the most common treatments for melasma is sun protection. Since sunlight triggers melasma, it is important to wear sunscreen every day, even on cloudy days and after swimming or sweating. Choose a sunscreen that offers broad-spectrum protection, a Sun Protection Factor (SPF) of 30 or more, and zinc oxide and/or titanium dioxide to physically limit the effects of the sun’s rays on your skin. Apply sunscreen 15 minutes before going outside and reapply at least every two hours.
Wear a wide-brimmed hat when you’re outside: As a recent study in the journal Nature illustrates, sunscreen alone may not give you the sun protection you need. Whenever possible, seek shade and wear protective clothing in addition to applying sunscreen.
Choose gentle skin care products: Choose skin care products that don’t sting or burn, as products that irritate the skin may worsen melasma.
Avoid waxing: Waxing may cause skin inflammation which can worsen melasma, so it’s important to avoid waxing areas of the body affected by the condition. Ask a dermatologist about other types of hair removal that may be right for you.
If your melasma does not go away, see a board-certified dermatologist to discuss available treatments for melasma, such as prescription medications or in-office procedures.
Shopping for a home remedy to cure skin cancer: People are often unaware of how harmful these all-natural remedies can be.
It’s said that every story has two sides. This is certainly true when it comes to vitamins, herbs, and other natural treatments for skin cancer.
When shopping for natural skin ...
Rosacea: Left untreated, rosacea can get worse.
Rosacea: Overview
Rosacea (rose-AY-sha) is a common skin disease. It often begins with a tendency to blush or flush more easily than other people.
The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, ...
Cold sore on and above the lip: Cold sores are so contagious that many people catch the virus that causes them by the time they’re 5 years old.
Cold sores: Overview
Also known as fever blisters or herpes simplex labialis
What is a cold sore?
A cold sore is a small blister or group of blisters that ...
A dermatologist's top tips for a healthy beard
How to care for facial hair
Healthy-looking facial hair starts with healthy skin. With the right skin care, it’s possible to prevent problems like dandruff, ingrown hair, acne, and itch.
To keep your facial hair healthy, follow these tips from ...
Isotretinoin: Overview
Acne can decrease self-confidence and may cause you to avoid social situations.
Isotretinoin (eye-soh-tret-in-OH-in) is a prescription medication for severe acne. This type of acne causes deep, painful cysts and nodules, which can be the size of a pencil eraser or larger. As ...
Back acne: How to see clearer skin
Dermatologists recommend wearing sweat-wicking clothes when working out.
If you have acne on your back—or “bacne” as some people call it—you don’t have to wait for it to clear on its own. Treatment and the right skin care can help you see clearer skin more ...
9 things to try when acne won’t clear
Popping a pimple often worsens acne.
Do you feel you’ve tried just about everything to get rid of your acne but still see blemishes? Don’t despair. To see clearer skin, you probably just need to make some changes.
The following tips from dermatologists can ...
9 things to try when acne won’t clear
Laser hair removal: Common misconceptions
A lot of misconceptions exist about what laser hair removal is and what it can and can’t do. Is it permanent? Does it work on light-colored hair? In this video, board-certified dermatologist Dr. Carolyn Jacob ...
Sarcoidosis and your skin: Who gets and causes
Who gets sarcoidosis?
People around the world get this disease. Studies indicate that sarcoidosis is most common in:
Women
Adults (rare in children)
Scandinavians
In the United States, African American women tend to develop sarcoidosis more often ...
How to care for your baby's skin, hair, and nails
How to care for your baby's skin, hair, and nails
These five tips from dermatologists can make caring for your baby’s delicate skin, hair, and nails easier and less intimidating.
Bringing home a new baby is a time of joy and excitement. ...