Melasma is a skin condition characterized by brown or blue-gray patches or freckle-like spots. It’s often called the “mask of pregnancy.” Melasma happens because of overproduction of the cells that make the color of your skin. It is common, harmless and some treatments may help. Melasma usually fades after a few months.
Melasma is a common skin disorder. Loosely translated, the word means “black spot.” If you have melasma you’re probably experiencing light brown, dark brown and/or blue-gray patches on your skin. They can appear as flat patches or freckle-like spots. Commonly affected areas include your face, including the cheeks, upper lip and forehead, as well as the forearms. Melasma is sometimes called the “mask of pregnancy” because it frequently affects pregnant women. Melasma typically darkens and lightens over time, often getting worse in the summer and better in the winter.
Another, less common name for melasma, is chloasma. Although this disorder is completely harmless, it understandably makes some people feel self-conscious.
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Melasma appears most commonly on your cheeks, nose, chin, above the upper lip and the forehead. It sometimes affects your arms, neck and back. In fact, melasma can affect any part of your skin that is exposed to sunlight. That’s why most people with melasma notice that their symptoms worsen during the summer months.
Melasma is a very common skin disorder, especially among pregnant women. 15% to 50% of pregnant women get it. Between 1.5% and 33% of the population may get melasma and it happens more often during a woman’s reproductive years, and rarely happens during puberty. It usually starts between 20 and 40 years of age.
Fairer-skinned people are less likely to be affected by melasma than those with darker brown skin or those who tan well. Women are more likely to get melasma than men: about 10% of those who get melasma are men, 90% women. Pregnant women get melasma more often than anyone else. You’re also at risk if you take oral contraceptives and hormones.
Your skin is made up of three layers. The outer layer is the epidermis, the middle is the dermis, and the deepest layer is the subcutis. It’s an organ – the largest organ – and it makes up about one-seventh of your body weight. Your skin is your barricade. It protects your bones, muscles, organs and everything else from the cold, from germs, sunshine, moisture, toxic substances, injury and more. It also helps regulate your body temperature, prevent hydration and feel sensations like the warmth of the stove, the fur on your dog’s belly and the pressure of someone else’s hand holding yours.
Your epidermis contains cells called melanocytes that store and produce a dark color (pigment) known as melanin. In response to light, heat, or ultraviolet radiation or by hormonal stimulation, the melanocytes produce more melanin, and that’s why your skin darkens.
Pregnant women have increased levels of the hormones estrogen and progesterone. These hormones are thought to contribute to your melasma. The darker color usually fades after pregnancy.
There are three types of melasma and they have to do with the depth of the pigment. A Wood’s lamp that emits black light may be used to determine the depth of the pigment. The three types are:
Melasma is not cancerous, a sign of cancer, or a skin condition that “turns into” cancer. However, there are skin cancers that may mimic melasma, so seeing your dermatologist is often recommended to confirm the correct diagnosis.
Melasma is a typically chronic disorder. This means that it’s long-lasting (three months or more). Some people have melasma for years or their entire lives. Other people may have melasma for just a short time, such as during pregnancy.
Melasma is harmless. It’s not painful, itchy, or uncomfortable in any way.
There are two main causes of melasma: radiation, whether ultraviolet, visible light, or infrared (heat) light; and hormones.
Ultraviolet and infrared radiation from the sun are key in making melasma worse. Other possible causes of melasma include:
Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. Sometimes the patches can become red or inflamed. Melasma appears in six locations or a combination of locations on your skin:
Your healthcare provider will decide for sure if you have melasma or another type of skin disorder.
At this time no foods or drinks are known by experts to directly cause, magically cure or worsen melasma. However, to keep your skin healthy in general, try a skin-healthy diet of foods rich in Vitamin D:
Those with melasma are more likely to have a thyroid disease. Your healthcare provider may test your thyroid.
Your dermatologist or other healthcare provider will examine your skin to diagnose melasma. They’ll use a Wood’s lamp (a black light) to see changes in the color of your skin. You might have your thyroid checked because there does seem to be an association between thyroid disease and melasma.
Melasma can sometimes be mistaken for another skin condition. To tell the difference between skin conditions, your healthcare provider may perform a biopsy, which is where a small piece of your skin is removed and examined. A biopsy is quick, safe procedure routinely performed during a normal visit to your healthcare provider’s office. Skin conditions commonly confused with melasma include:
If you have melasma, the results of the biopsy will typically reveal the following:
The severity of your melasma can be measured by using the Melasma Area and Severity Index (MASI). Your healthcare provider may administer the test.
Melasma is usually flat. See your healthcare provider if you have concerns about another type of skin disorder.
No. Melasma appears slowly over a period of weeks or months.
Spots of melasma can sometimes be mistaken for freckles but they are not the same skin condition.
They can look similar! But, melasma patches are almost always larger than what we call age spots, sun spots, or liver spots. Ask your healthcare provider if you’re concerned about another condition.
Melasma is hard to treat. To determine a treatment plan, your healthcare provider will have to first figure out what’s possibly causing the melasma. Is it sunlight? Your birth control? Genetics? Your soap? Too much screen time?
Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months. Most cases of melasma will fade away with time and especially with good protection from sunlight and other sources of light.
Unfortunately, there is no definitive treatment that will automatically make melasma disappear. At this time there is no way to remove dermal pigment.
If you have melasma, be sure to avoid:
Yes. A dermatologist will be able to perform treatments that your usual healthcare provider may not be able to.
Yes, it’s possible that your melasma will go away on its own within a few months. However, it is not likely to go away while you’re pregnant or taking hormone contraceptives. Take preventative steps like avoiding sunlight to keep your melasma from getting worse or, if it does fade away, to keep it from coming back. Melasma can return.
The first thing you need to do to treat your melasma is to make sure that it doesn’t get any worse. Do this by avoiding the sun, tanning beds, LED screens, irritating soaps and birth control that includes hormones. If you are exposed to the sun, be sure to wear sunscreen with iron oxides and a SPF of 30-50 applied every two hours, as well as a wide-brimmed hat. These steps may prevent your melasma from getting worse.
The second path to take is topical medications. Topical therapy using tyrosinase inhibitors prevents new pigment formations by stopping the formation of melanin (the dark color). Examples of tyrosinase inhibitors and other types of helpful agents include:
The combination of hydroquinone, tretinoin and a moderate topical steroid has had the best effect on melasma.
Other agents that are being studied to improve melasma include:
Dermatitis is a side effect of hydroquinone and tretinoin. Azelaic cream, lotion, or gel can sting. Always be on the lookout for any allergic reactions. Report all side effects to your healthcare provider. It might be appropriate for you to use a different medication to avoid the side effects.
Chemical peels and lasers may cause the surface layers of skin to die, cause post-procedure hyperpigmentation, and cause hypertrophic scars. They can be safely used with topical medications, but only by specialists who have experience treating melasma.
It depends on the person and the medication used. Melasma can be slow to respond to treatment. The agents listed above rarely eradicate all of the melasma.
A topical treatment isn’t your only option. There are some procedures that your dermatologist can do to improve your melasma.
Your melasma is likely to go away when you’re no longer pregnant. If it doesn’t, pursue treatment options with your healthcare provider. While pregnant, be careful to only use topical and oral treatments that are approved for pregnant women.
A dermatologist specializes in skin conditions. They can help you with management and treatment of your melasma.
Yes, but use cosmetics that include sunscreen and pay attention to any that may aggravate your melasma by irritating your skin.
Vitamin D helps keep your skin healthy in general. Your healthcare provider might test your vitamin D levels to make sure that you’re getting enough of it from high vitamin D foods such as meat, cereals, oily fish and eggs. You could also take a vitamin D supplement. Start at 2,000 International Units (IU) per day.
If the hormones in your contraception are the cause of your melasma then, yes, it may go away. Typically it takes about three or more months for the melasma to fade.
Melasma will likely fade within three months after you’re no longer pregnant.
Regrettably, you can’t avoid genetics, or stop the skin condition when you’re pregnant. But you may be able to avoid the factors listed above which make melasma worse. At this time no medication can completely prevent melasma. However, a skin-friendly diet including adequate amounts of vitamin D is likely to help.
Melasma is a harmless skin condition. It doesn’t itch or hurt, and it doesn’t become malignant. Expect it to get worse and/or reoccur if you don’t take steps such as avoiding the sun and makeups and soaps that irritate your skin.
If you have the dermal pigment, it may take longer to fade away than if you have the epidermal pigment. Melasma is typically a chronic disorder. This means that it’s long-lasting (three months or more). Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment. If you take preventative measures and follow any treatments recommended by your healthcare provider, your melasma might disappear.
Avoid exposure to sunlight without sunscreen. Cut down on screen time in front of your LED screen television, tablet, mobile phone and computer. Choose a method of birth control that doesn’t include hormones. Use the treatment and management advice from your dermatologist or another healthcare provider. And make sure you’re getting the right treatment by confirming the diagnosis with your healthcare provider.
Melasma is harmless, physically, but can have an emotional impact. Some people may feel embarrassed to allow others to see their skin condition. Fortunately, melasma typically fades after about three months.
To start treatment, see your healthcare provider as soon as possible when you see signs of melasma. The worse it gets, the harder it will be for treatments to work.
A note from Cleveland Clinic
Melasma is common, normal and harmless, but it can be bothersome. This skin disorder can affect your social life if you’re feeling self-conscious about it. But you don’t have to just “live with it.” There are treatment options. There are preventative measures you can take. There are dermatologists who can help you. Ask them questions and voice your concerns.
Always listen to the advice of your healthcare provider and follow your treatment plan carefully.
Last reviewed by a Cleveland Clinic medical professional on 07/27/2020.
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