Melasma is a skin condition of increased blotchy pigment of skin on the face. It is characterized by brown patches on the cheeks, forehead, chin and lips. It can also occur on the arms. It is much more common in women than men and tends to occur more frequently in patients who tan easily or have darker skin types. Melasma is sometimes referred to as “the mask of pregnancy” or chloasma. It can be triggered by the hormonal changes of pregnancy, oral contraceptive pills, and hormone replacement therapy. Many times, however, a trigger is not identified.
Unfortunately, discontinuation of an identified trigger does not always stop the melasma.
People with melasma see a symmetric darkening of their skin in any variety of patterns. The darkening is not itchy or symptomatic. Usually, people just find the discoloration cosmetically disturbing.
Melasma is speculated to be triggered by internal hormones or the hormones of pregnancy. There is likely to be a genetic component of melasma, although commonly people afflicted do not have family members with this condition. Melasma is also very sensitive to sunlight, which can make the pigment even darker.
Melasma is usually diagnosed clinically without invasive testing. It can be confused, however, with other conditions such as post-inflammatory hyperpigmentation (increased pigment following inflammation or a rash of any type), lentigines or “sun spots”, medication-induced pigment changes, and other less common rashes or birthmarks.
There are various treatment options for melasma. Fortunately, in the case of pregnancy-or hormone-induced melasma, the problem can sometimes slowly resolve even without treatment. In most cases, however, it is a stubborn condition that requires time and patience with the treatment regimen.
Dermatologists can prescribe bleaching agents such as hydroquinone, topical retinoids such as tretinoin, a topical anti-inflammatory agent such as azelaic acid, or perform procedures such as chemical peels or treatment with lasers. There are many OTC options that are milder than these prescription products.
Melasma is extremely sun-sensitive, so be sure to use sunblock diligently year-round.
OTC Treatment Options
Melasma OTC Treatment
Pigmentclar Serum Visible Dark Spot Reducer La Roche Posay (PhE resorcinol)
Elta MD UV Clear SPF 46 (with or without tint)
Murad Rapid Age Spot & Pigment Lightening Serum (2% hydroquinone)
Melasma is extremely sensitive to sunlight, particularly ultraviolet A light which is present in ample quantity year round. Thus, part of any successful treatment regimen involves diligent protection year-round with a broad spectrum sunblock. Irritation or inflammation of the skin can also induce hyperpigmentation (darkening of skin), so avoidance of waxing of affected areas and cosmetics or other skin care products which irritate is essential.
Small gains in treatment can be rapidly reversed with even short, unprotected exposure to the sun, so be careful!
If melasma persists despite the above measures, seek evaluation by a dermatologist. While melasma is a stubborn problem, prescription products and in-office procedures may produce better results.