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What is melasma (skin hyperpigmentation)?

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What is melasma (skin hyperpigmentation)?

Melasma is a common skin condition that causes brown or grey-coloured patches to develop on sun-exposed areas of skin, particularly the face. These patches are known as hyperpigmentation.

Melasma is more common in women, especially during pregnancy, and in people with darker skin.

The condition is also sometimes known as ‘chloasma’ or the ‘pregnancy mask’.

Melasma tends to look darker in the summer and lighter in the winter. And even though it is linked to sun exposure, melasma does not lead to skin cancer.

Melasma symptoms

If you have melasma, the main symptom you are likely to notice is a gradual darkening of your skin.

This darkening (hyperpigmentation) is typically:

  • on the face (usually the forehead, cheeks, nose and upper lip, sometimes the sides of the cheeks and jawline), but can also be on the neck and forearms
  • symmetrical in nature (occurs on the same area on both sides of the face and body)
  • brown in colour, but may be black or have a bluish tinge
  • made worse by sun exposure

Melasma does not tend to be itchy or painful but, for some people, the visible changes in appearance caused by melasma can be upsetting.

What is the main cause of melasma?

The exact cause of melasma is currently unknown, but it is thought to happen when pigment-producing cells (melanocytes) produce too much skin pigment (melanin).

Certain factors can increase your risk of developing the condition, including:

  • being female
  • sun exposure
  • changes in hormone levels - caused by factors such as pregnancy, thyroid disease or taking the oral contraceptive pill
  • dark skin types
  • genetics - it often runs in families
  • certain medications - such as those used to treat seizures
  • some types of cosmetics
  • low levels of the mineral zinc

How is melasma diagnosed?

A doctor will usually examine your skin before diagnosing melasma. They are also likely to ask you questions about the skin changes, your medical history, past pregnancies, family medical history, medication and other relevant factors.

In some cases, your doctor may also look at your skin using a lamp (Wood’s lamp) that produces a special type of light.

If your doctor is not sure that your symptoms are due to melasma, they may recommend a skin biopsy to exclude other conditions. This is normally carried out by a skin specialist (dermatologist).

What is the best treatment for melasma?

Melasma can be hard to manage because sun exposure makes it worse, and it can be very difficult to completely avoid sunlight.

However, treatment of the condition aims to lighten any dark patches of hyperpigmentation you have and to prevent new ones from forming.

Treatments to lighten existing patches

To lighten dark patches, your doctor may recommend creams that contain skin-lightening agents such as hydroquinone, tretinoin, azelaic acid and kojic acid.

As these creams can irritate the skin, they may be prescribed in combination with a steroid cream.

Once the patch has faded, you may need to continue using the lightening cream for up to 6 months.

Long-term use of steroid creams on the face can cause skin damage. If you are given a steroid cream to manage melasma, ask your doctor for advice on how much to use and how long to use it for.

Treatments to prevent new patches from forming

You can help to prevent new patches from forming by following these sun safety and self-care actions all year round:

  • avoid the sun as much as possible
  • always wear sunscreen that provides broad-spectrum UV protection (SPF 30 or above, with a high UVA rating). The higher the SPF, the more effective it will be.
  • wear a wide-brimmed hat when outside
  • avoid tanning beds
  • avoid cosmetics that may have ingredients that make your skin more sensitive to sunlight

Read more about sunscreen and sun safety.

If you are taking medication that may be the cause of your symptoms, your doctor may consider stopping or changing it. This includes the oral contraceptive pill.

Procedures to treat melasma

If lightening creams and avoiding exposure to sunlight have done little to improve the appearance of any dark patches you have, you may be referred to a dermatologist for a skin-lightening procedure, such as:

  • chemical peels - these improve melasma by removing the outermost cells of the skin that contain the pigment.
  • Laser treatment - these can remove the outer layer of skin or target pigment-producing cells in the skin.

The effects of these treatments vary from person to person, and you will need to protect your skin from the sun after treatment.

Treatments to cover melasma

If you feel upset by how your skin looks, you can cover any dark patches you have with a type of skin makeup called skin camouflage. It is a thick, coloured cream that is matched to your natural skin colour by a specialist.

Your doctor or dermatologist may be able to provide advice about where to find a skin camouflage service.

Is there a cure for melasma?

There is currently no cure for melasma and it is often a long-term condition that may improve with treatment, but return once you stop treatment. Too much sun exposure can also increase the risk of melasma returning.

If you have melasma, the most important thing you can do to manage your symptoms is to protect your skin from exposure to sunlight.

Melasma can negatively affect quality of life because of its effect on your appearance. If you are upset by the appearance of your skin, speak to your doctor. They should be able to provide advice on support services you may find useful.

If you are worried that you may have melasma, check your symptoms by downloading our free Self-Assessment Tool.

Related articles

Sunscreen and sun safety

Underactive thyroid - hypothyroidism

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Combined pill

Vitamins and supplements during pregnancy

Date of last review: 26 June 2020

References

[Internet]. Bad.org.uk. 2020 [cited 31 January 2020]. Available here.

UpToDate [Internet]. Uptodate.com. 2020 [cited 31 January 2020]. Available here.

Melasma (syn. chloasma) [Internet]. Pcds.org.uk. 2020 [cited 31 January 2020]. Available here.

Harding D. Chloasma (Melasma). Facial pigmentation information. Patient [Internet]. Patient.info. 2020 [cited 31 January 2020]. Available here.

Melasma - Symptoms, diagnosis and treatment | BMJ Best Practice [Internet]. Bestpractice.bmj.com. 2020 [cited 31 January 2020]. Available here.

UpToDate [Internet]. Uptodate.com. 2020 [cited 31 January 2020]. Available here.

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