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Medical Dermatology

Melasma

What is melasma?

Melasma is a common skin condition that causes blotchy patches of hyperpigmented skin that appear as tan to gray-brown discoloration on the cheeks, forehead, chin, and upper lip. However, it can appear on any area that is frequently exposed to the sun including the forearms and neck. Melasma develops over time and is more common in darker skin types and people with a family history of melasma.

Melasma is seen more frequently in women than men. It is common in during pregnancy and has been called “the mask of pregnancy.” However, melasma can affect men and women of all ages and can last for years or decades and can negatively affect a patient’s self-image, self-esteem and confidence.

What causes melasma?

The cause of melasma is unclear, but sun exposure and fluctuations in hormone levels activate the skin cells, called melanocytes, to produce excess melanin, the substance that gives skin its color. People of color are more prone to melasma because they have more active melanocytes than people with light skin. Melasma often runs in families.

Common melasma triggers include:

  • Ultraviolet (UV) light from the sun is the most common trigger and can aggravate underlying causes like hormonal changes. Even a short exposure to the sun’s light and heat can worsen existing melasma and cause it to return after treatment.
  • Hormone fluctuations common during pregnancy, oral contraceptives or hormone replacement therapy are known to cause melasma.
  • Skin care products or procedures that irritate the skin can also worsen melasma.

How is melasma diagnosed?

Because of its characteristic appearance, melasma is often diagnosed visually and with the use of a Wood’s Lamp which can distinguish excess melanin in the top skin layer from discoloration in the second layer of the skin. Your doctor will also ask questions about your sun exposure, medications, and skin care regimen to help guide an individualized treatment plan.

How is melasma treated?

If melasma is associated with pregnancy or birth control pills, it may fade after a woman delivers her baby or stops taking the pills. However, many patients continue to have melasma for years and treatments are ongoing given that the disease is chronic.

Sun protection and sun avoidance is absolutely essential to prevent melasma and improve results with other treatments. This includes wearing sunscreen with SPF 50 or greater daily and reapplying every 1-2 hours if outdoors. Patients should also wear a wide-brimmed hat, sunglasses, and seek shade when outdoors to help protect their skin. A sunscreen with a physical blocking agent such as zinc oxide and/or titanium dioxide is the best option for a patient with melasma.

Topical medications are often prescribed to lighten the patches of melasma. Hydroquinone cream is a bleaching agent that works by decreasing the production of pigment. This may be combined with retinoids, kojic acid, azaleic acid, and corticosteroids to optimize your treatment and get the best results. In severe cases, an oral medication called tranexamic acid may be considered. If at any time a skin care product is irritating the skin, it should be stopped – as irritation can worsen melasma.

Additional treatments include chemical peels and laser treatment. Combination treatments can be very effective. Both topical treatments and procedural treatments require consistency and sun avoidance for optimal results.

In a sunny state like Arizona, melasma is a frustrating, chronic condition. At Phoenix Surgical Dermatology Group, your board-certified dermatologist will work with you to obtain a more even skin tone and restore your natural glow. Contact us today to schedule a consultation and learn more about your options.


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