What is melasma?

Melasma is a common skin issue that is characterized by brown to gray-brown patches on the skin — typically on the face. Although most people with melasma get it on their cheeks, bridge of the nose, forehead, chin and above the upper lip, it can also be present on the forearms and neck.

Causes of melasma

Although the exact cause of melasma is unknown, it likely occurs when the melanocytes (cells in the skin that produce color) produce too much color. People with darker skin tones are more likely to develop melasma than light-skinned people because they have more active melanocytes.

Risk factors for melasma

There are a variety of factors that increase your likelihood of developing melasma. Risk factors include:

  • People with darker skin tones are more likely to develop melasma.
  • People with a family member with the condition are more likely to develop melasma.
  • Women are more likely to develop melasma than men. Approximately 90 percent of cases are women.

Symptoms of melasma

The most common sign you have melasma is the presence of brown or gray-brown spots on the skin that appear on the cheeks, forehead, nose, above the lip, chin, neck and/or forearm.

Diagnosis of melasma

Your dermatologist can diagnose melasma by looking at your skin. To evaluate how deep the melasma penetrates the skin, your dermatologist may look at your skin under a Wood’s light.

In some cases, your doctor may perform a skin biopsy to examine your skin cells under a microscope. This may be performed to rule out other skin conditions that may look similar.

Treatments for melasma

The most common treatment for melasma is to protect yourself from the sun. You should apply sunscreen every day and reapply as directed. You should also take other precautions to avoid the sun such as wearing a wide-brimmed hat and protective cover-ups. If you have developed melasma as a result of taking birth control pills or while pregnant, the condition can improve after you stop taking the pills or the baby is born.

If melasma does not recede naturally, you may need treatment. Medical treatments for melasma include:

  • Hydroquinone
    Hydroquinone is a first-line therapy for melasma. When applied directly to the skin, it can lighten the skin. It is available as a liquid, gel, lotion or cream.
  • Corticosteroids or tretinoin
    Medications that contain tretinoin or corticosteroid can help enhance skin lightening. These medications can be used in combination with hydroquinone.
  • Topical azelaic and kojic
    These medications can lighten melasma when applied directly to the skin.

If medication alone is not effective, you may need a medical procedure such as a chemical peel, microdermabrasion, dermabrasion or laser treatment to treat melasma. Treatment should be tailored to your condition.

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