What Is Melasma?
Melasma is a dark discoloration of the skin on the face. An area of skin will look tan or brown, darker than the normal skin tone and with a uniform color. The cheeks, forehead, nose, and upper lip are often affected. The discoloration may be confined to the cheekbone area, the central face, or the jaw. The pattern is usually the same on both sides of the face. The darkening occurs gradually. Melasma has no other symptoms. Skin does not become inflamed and it does not hurt. This condition is not known to lead to any other medical problems.
The discoloration seems to be related to sun exposure. It's also associated with the female hormone progesterone. Sometimes it occurs in people with thyroid problems. Drugs that make the skin sensitive to the sun can raise the risk of melasma.
When it occurs in pregnant women, the skin darkening is also called chloasma or "the mask of pregnancy."
Who Gets It?
Anyone can get melasma. About 90 percent of people affected are female. It's also more common in:
- People who live in tropical areas (probably because of increased exposure to the sun)
- Pregnant women, due to the high levels of estrogen and progesterone
- Young women with dark skin
- People whose relatives have it
Your doctor can tell you if your skin problem is melasma. In most cases, this problem can be diagnosed without any special tests.Sometimes, the doctor will use a special light called a "Wood's lamp." The light lets the doctor see the discoloration more clearly. It helps him or her tell which layers of skin are affected.
Occasionally, the doctor will take a small sample of skin, called a biopsy, to make sure that there isn't a more serious problem.
Treatment is intended to help with the discoloration and make the skin look better. Treatments include:
- Sun protection. Sunscreen and sun avoidance won't cure melasma, but they will help keep it from worsening or coming back. Using high-SPF sunscreen and staying out of the sun are important parts of treatment. To be effective, the sunscreen must block both UVA and UVB rays.
- Hydroquinone (HQ) cream. HQ is a drug that reduces the production of melanin, the coloring agent in skin. It's sold in low concentrations as "bleaching cream" at the drugstore. Stronger formulas must be prescribed by a doctor. Side effects include sensitivity to sun, skin irritation, and the risk of further discoloration.
- Tretinoin cream. Tretinoin works more slowly than HQ. It may be combined with other medicines, such as steroids. It can also cause sun sensitivity and discoloration.
- Azelaic acid. Originally used as an acne treatment, azelaic acid can also help with this condition. It has a somewhat higher risk of skin irritation than HQ.
- Steroid cream. In combination with other medicines, steroid cream may help speed improvement.
Chemical peels and laser treatments are sometimes suggested, and they may help in some cases. However, both can cause skin darkening and other complications in some patients. Dark-skinned people are particularly at risk for skin darkening from chemical peels. These treatments should be done only with a doctor's guidance.
In addition, the following may be helpful:
- Stopping birth control pills. Since the problem is associated with the hormones in birth control pills, it may get better once the pills are stopped.
- Avoiding irritants. Soaps and facial treatments that irritate the skin can worsen melasma.
Facial discoloration related to pregnancy will often fade after the baby is born. In many cases, it goes away completely. Both during and after the pregnancy, a dermatologist can help to minimize the problem. He or she can also offer advice on what medicines are safe during pregnancy.