Since you and your skin go way back, you probably have a pretty good idea of what it should and shouldn’t look like on a regular basis. It’s no wonder why you might be confused when melasma's hallmark brown spots start to develop on different parts of your face.
Melasma is a harmless but potentially annoying condition that causes blotchy dark patches to show up on your skin. “It is a condition that I see daily in my practice,” Joshua Zeichner, M.D., a New York City–based board-certified dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center, tells SELF. Here’s what you need to know about melasma, plus how to lower the odds you’ll develop these spots at all.
Experts think melasma likely happens when your melanocytes (the color-making cells in your skin) go a little overboard in making the dark pigment known as melanin.
The result: brown or gray-brown patches that start to dapple your skin, the American Academy of Dermatology (AAD) explains. Melasma most commonly shows up on the cheeks, bridge of the nose, forehead, chin, and above the upper lip. It can also appear on other parts of the body that get a lot of sun, like your forearms and neck.
People of color are most susceptible to melasma because they have more active melanocytes than those with lighter skin, according to the AAD. Still, anyone can develop this condition.
When it comes to melasma causes, there does seem to be a genetic link. Other factors such as hormones can play a huge role as well.
Many people with melasma also have relatives with the condition, the AAD notes. Beyond that, sun exposure is key. Ultraviolet light prompts melanocytes to churn out more melanin, which is why your melasma may get worse in the summer and better in the winter. This is also why even a small amount of time in the sun can make melasma return with a vengeance after it has faded.
Mind-blowingly enough, 90 percent of melasma cases are in women, per the AAD. The reason behind this still isn’t totally clear, though, Bruce A. Brod, M.D., clinical professor of dermatology and co-director of the Occupational and Contact Dermatitis Program at Penn Medicine, tells SELF. It's likely due in part to the types of hormonal changes more common in women, like those you experience if you’re pregnant, on some kinds of birth control, or on hormone replacement therapy. “Melasma is referred to as the ‘mask of pregnancy,’ as women commonly develop it for the first time or experience worsening melasma while they are pregnant,” Dr. Zeichner says. There’s no clear mechanism linking increased hormone levels with melasma, but it seems as though estrogen and progesterone may trigger melanogenesis, or the production of melanin. During pregnancy, there even appear to be higher levels of what’s known as melanocyte-stimulating hormone. It may also be possible that people prone to melasma have more sensitive hormone receptors in their hyperpigmented areas compared with their regularly pigmented skin.
Still, there are a lot of questions surrounding melasma. “We don’t know how the process works that leads to it,” Cynthia Bailey, M.D., a diplomate of the American Board of Dermatology and founder of DrBaileySkinCare.com tells SELF.
If you think you have melasma, see your doctor for a proper diagnosis.
It seems like a melasma diagnosis would be pretty straightforward, but it can be easy to confuse it with other conditions like post-inflammatory hyperpigmentation (brown spots left behind by a skin injury like acne) or solar lentigines (liver spots), Dr. Bailey says. Most of the time, your doctor will diagnose you with a skin exam, but they may also take a biopsy (small skin sample) to rule out other conditions, according to the AAD. In addition, they might use a device called a Wood’s light that shines UV light on your skin to see how deep your melasma goes.
Melasma can fade on its own, and topical treatments may help if it doesn’t.
But if that’s not what’s behind your melasma or you don’t want to change your birth control method, there are a few treatments your dermatologist may recommend.
Hydroquinone is often the first-line treatment for melasma, according to the AAD. This drug lightens skin by affecting melanin production in the targeted areas, and you can get it over-the-counter or in a prescription (the prescription-strength stuff will be stronger). Your derm might actually suggest triple combination therapy, which is a cream that combines hydroquinone with tretinoin (a powerful retinoid that suppresses melanin synthesis) and a corticosteroid (this can calm inflammation from the other two ingredients and dampen your melanocytes’ activity). Alternatives include azelaic acid and kojic acid, which both also hinder how your melanocytes work. Be sure to ask your doctor what kind of side effects and red flags to look out for with these treatments, as they can sometimes cause issues like irritation.
If none of the above does the trick, your doctor may recommend a chemical peel, microdermabrasion, dermabrasion, laser treatment, or a light-based procedure to try to get rid of your spots, the AAD says.
It may take some persistence to land on the right melasma treatment for you, Dr. Brod explains. Even once you do, it can take months of consistent application to see a change. It's frustrating, but don't give up early because you’re not seeing the results you want.
As you treat your melasma, you may need to rethink your normal skin-care routine in case it might worsen your condition.
Harsh skin-care products make melasma worse, the AAD says, which is why it’s best to go with gentle ones when you have this condition. If you’re not sure it’s OK to continue with your normal skin-care routine while treating your melasma, ask your doctor.
You should also take a hard pass on waxing over any areas where you have melasma since it can cause skin inflammation that can exacerbate your condition, the AAD says. And make sure you keep up with your sunscreen, too, because…
Sun protection is crucial for preventing melasma in the first place (and keeping your current melasma from sticking around or intensifying).
Safeguarding your skin from the sun is an excellent defense against melasma. The AAD recommends wearing broad-spectrum sunscreen of at least SPF30 every day to ward off both Ultraviolet A (UVA) and Ultraviolet B (UVB) rays. (The former makes your skin age more quickly, the latter provokes sunburns, and both can cause skin cancer, according to the Mayo Clinic.) Reapply your sunscreen as recommended, and wear a wide-brimmed hat to shield your face when you’re outside. If you can avoid going out in the middle of the day when the sun’s rays are the strongest, that’s a good idea, too, Dr. Brod says.
Even low levels of UV light can stimulate your melanocytes and raise your risk of melasma, Dr. Zeichner says, so you really don’t want to shirk sun protection, even on cloudy days. If you want to make sure your sun safety is up to par, check out these mistakes to avoid when you're out enjoying the sunshine.