Table of ContentsView AllTable of ContentsSymptomsCausesRisk FactorsDiagnosisOther Causal ConditionsTreatmentPreventionCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Risk Factors
Diagnosis
Other Causal Conditions
Treatment
Prevention
Coping
Melasma is a common skin pigmentation issue that causes dark, blotchy, and uneven skin tone on sun-exposed areas, chiefly on the face. Melasma symptoms are more common in women than in men and generally appear for the first time during reproductive age or pregnancy.
Although it’s medically harmless, for many people the discoloration is a cause of embarrassment so it is common to seek treatment. Melasma is also called chloasma or the mask of pregnancy.
This article discusses melasma symptoms, causes and risk factors, and potential treatment options for this skin condition.
Verywell / Alexandra Gordon
Dark Patches on Face
Melasma causes hyperpigmentation or discolored marks that are darker than your surrounding skin. The skin looks blotchy and uneven, with irregular borders on the discolored spots.
Appears on Sun-Exposed Skin
Melasma develops on sun-exposed areas of the skin, most often the face. Above the upper lip, across the cheeks, nose, and forehead are all very common areas to find it, but melasma can develop anywhere on the face. It also can develop on the chest, upper arms, and upper back, though not as frequently.
Symmetrical
The key factor with melasma is that it typically appears symmetrically on the face.You’ll notice “matching” patches on both cheeks, or spots that have developed evenly across the nose or the forehead.
May Cover a Large Area
Patches of melasma can join together, forming one or more larger areas of hyperpigmentation.
Color and Darkness Can Vary
The discoloration can range from slightly darker than your normal skin color to extremely dark.Depending on your skin toneand the severity of your melasma, the discoloration can be light brown to nearly black.
In persons with darker skin tones, melasma can appear bluish-gray in color.
Painless
These areas of discoloration don’t hurt, burn, or itch. In fact, you won’t notice anything different about these areas of skin aside from the fact they’re discolored.
Melasma on MenAlthough melasma is most common in women, it can develop in some men.
Melasma on Men
Although melasma is most common in women, it can develop in some men.
This photo contains content that some people may find graphic or disturbing.See PhotoMelasma on face.DermNet / CC BY-NC-NDOwner
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Melasma develops when there is excessmelaninin certain areas of the skin.Melanin is the substance that gives your skin, eyes, and hair their color. People with dark complexions have skin that produces more melanin; those with lighter complexions have less melanin.
Melanocytesare cells in your skin that create melanin. For reasons that aren’t clear, these cells sometimes malfunction and start making more melanin in certain areas than in others. The excess melanin produces the dark, blotchy areas we know as melasma.
With melasma, the discoloration is limited to theepidermis, which is the outermost layer of the skin. However, research suggests that the deeper layers of the skin (thedermis) may also play a role in melasma development.
There are certain risk factors that make you more susceptible to developing melasma. The more of these factors you have, the more likely you are to develop melasma. But, in some cases, melasma develops without any apparent risk factor.
Complexion
If your complexion is olive, medium, to medium-dark toned, and you tan very easily, you have a higher chance of developing melasma than those with very light or very dark complexions. People who are most likely to develop melasma are those whose skin falls between a III and V on theFitzpatrick scale(a way of measuring skin tone, with I being the lightest complexions and VI being the darkest complexions). It isn’t as common in skin types that fall on the far ends of the spectrum.
Hormones
Melasma development is linked to increasedestrogen hormones. This explains why melasma is much more common in women than it is in men. Men can develop it, though, especially if there is a strong family history.
Sincethyroid problemsaffect the hormones, you also have a higher chance of developing melasma if you have thyroid issues.
Pregnancy
There’s a reason why melasma is also called the “mask of pregnancy.” Pregnant persons often develop this condition. Increased levels of estrogen andprogesteroneduring pregnancy are thought to trigger melasma in some people.
Sun Exposure
Another huge trigger factor in melasma development is excessive sun exposure. In fact, you may notice your melasma looks more obvious during the sunnier summer months and fades a bit during the winter. The sun’s ultraviolet rays stimulate the melanocytes to create more melanin.
In people with melasma, the dermis shows signs of prolonged sun exposure andsun damage.
Genetics
A person may be genetically predisposed to developing melasma. An overwhelming number of people with melasma also have relatives with the problem. So, if you have a strong family history, you should do your best to limit other triggers when possible.
Certain Drugs and Cosmetic Products
Certain medications may raise your risk of developing melasma. The list includes:
Also, any cosmetic products that make your skin more sensitive to the sun may increase your risk. However, none of these are considered primary risk factors.
Very rarely, your healthcare provider may do a biopsy of the affected area to confirm it is melasma. This is only done if there’s a question it may be another skin problem.
Other Conditions That Cause Skin Discoloration
There are manyskin conditions that cause hyperpigmentation. Most are fairly easy to differentiate from melasma, but some can look very similar, especially if you aren’t familiar with them.
Age Spots
Often called liver spots, age spots, or sun spots, the technical term for this type of hyperpigmentation is solarlentigines. Solar lentigines are round, oval, sometimes irregularly shaped, dark marks.
Like melasma, solar lentigines are flat areas of discoloration that develop over sun-exposed areas of skin. The difference is that melasma generally covers a larger area and develops symmetrically on the face. Solar lentigines are more common in fair complexions.
Post-Inflammatory Hyperpigmentation
The key difference betweenpost-inflammatory hyperpigmentationand melasma is the cause. Post-inflammatory hyperpigmentation develops after some sort of inflammatory wound: a cut, scrape, burn, eczema patch, orinflammatory acne. It’s not a scar, but rather a flat area of discolored skin left behind after the skin heals.
Freckles
Ephelides, more commonly known as freckles, can develop because of sun exposure. They look like they’re “sprinkled” across the skin, rather than in large patches.Certain skin types are more prone to them.
Melasma isn’t a harmful or contagious condition; it’s completely cosmetic.If it’s not bothering you, there is no medical reason to treat it.
In some cases, the discoloration may fade over time. This is most likely to happen if the melasma appeared during pregnancy.
Melasma is often a chronic condition, making it difficult to treat. Multiple factors like sun exposure, hormones, and skin type may contribute to the problem.
Topical productscan keep discoloration in check, but if you stop using them, the discoloration resurfaces. Be prepared to use some type of treatment long-term.
If you dochoose to treat it, you have several options.Your dermatologist will help you devise the best long-term treatment plan for your skin.
Prescription Topical Medications
Topical prescription medications are the mainstay of melasma treatment. Depending on what your healthcare provider decides is best for you, you may be prescribed:
An oral prescription medication called tranexamic acid is effective for melasma that is difficult to treat, but it does have risk factors. Ask your doctor if it is right for you.
Over-the-Counter Products
Although over-the-counter products aren’t the most effective options for treating melasma, they may help fade hyperpigmentation over time especially if the discoloration is rather minor. They also can be used as maintenance once you’ve achieved good results with other treatments.These include:
Procedural Treatments
In some cases, in-office procedures may be used to treat melasma. These are often used alongside other topical treatments. They include:
Whatever treatment option you choose, there is one key step that you mustn’t skip:sun protection. The sun is a huge factor when it comes to melasma development. No treatment will work well if you’re not also protecting your skin from the sun.
Sun Protection
Sun protection can’t end when your melasma treatment does. Once you’re happy with the results, you still must be diligent in your sun protection routine. Even a few hours of unprotected sun exposure can cause melasma to come back more severely.
Apply sunscreen of 30SPFor higher daily. You should apply sunscreen every day as part of your skincare routine, even when it’s cloudy or you’re only spending limited time outdoors.
If you are going to be outdoors for longer periods of time, reapply your sunscreen often. Wearing a hat is also a good idea.
It goes without saying you shouldn’t tan, either in the sun or in a tanning bed, if you’re trying to improve melasma. And don’t want to sunbathe while you’re pregnant since you’re more susceptible to developing melasma during pregnancy.
Here are a few tips to help you when you’re feeling discouraged or self-conscious.
Summary
An Overview of Vitiligo
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Grimes PE.Melasma: Epidemiology, pathogenesis, clinical presentation, and diagnosis. UpToDate.Handel AC, Miot LDB, Miot HA.Melasma: a clinical and epidemiological review.An Bras Dermatol. 2014;89(5):771-782. doi:10.1590/abd1806-4841.20143063American Academy of Dermatology.Melasma: signs and symptoms.Cestari TF, Dantas LP, Boza JC.Acquired hyperpigmentations.An Bras Dermatol. 2014;89(1):11-25. doi:10.1590/abd1806-4841.20142353Yamaguchi Y, Hearing VJ.Melanocytes and their diseases.Cold Spring Harb Perspect Med. 2014;4(5). doi:10.1101/cshperspect.a017046Ogbechie-Godec OA, Elbuluk N.Melasma: an Up-to-Date Comprehensive Review.Dermatol Ther. 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M.Melasma and thyroid disorders: a systematic review and meta‐analysis.Int J Dermatology. 2019;58(11):1231-1238. doi:10.1111/ijd.14497American Academy of Dermatology.Melasma: causes.Sarkar R, Ailawadi P, Garg S.Melasma in Men: A Review of Clinical, Etiological, and Management Issues.J Clin Aesthet Dermatol. 2018;11(2):53-59.Passeron T, Picardo M.Melasma, a photoaging disorder.Pigment Cell Melanoma Res. 2018;31(4):461-465. doi:10.1111/pcmr.12684American Academy of Dermatology.Melasma: Diagnosis and treatment.Hasegawa K, Fujiwara R, Sato K, et al.Possible Involvement of Keratinocyte Growth Factor in the Persistence of Hyperpigmentation in both Human Facial Solar Lentigines and Melasma.Ann Dermatol. 2015;27(5):626-629. doi:10.5021/ad.2015.27.5.626Plensdorf S, Livieratos M, Dada N.Pigmentation Disorders: Diagnosis and Management.Am Fam Physician. 2017;96(12):797-804.Praetorius C, Sturm RA, Steingrimsson E.Sun‐induced freckling: ephelides and solar lentigines.Pigment Cell Melanoma Res. 2014;27(3):339-350. doi:10.1111/pcmr.12232American Academy of Dermatology.Melasma: Overview.American Academy of Dermatology.Melasma: Self-care.Shankar K, Godse K, Aurangabadkar S, et al.Evidence-based treatment for melasma: expert opinion and a review.Dermatol Ther. 2014;4(2):165-186. doi:10.1007/s13555-014-0064-zGrimes PE, Ijaz S, Nashawati R, Kwak D.New oral and topical approaches for the treatment of melasma.Int J Womens Dermatol. 2019;5(1):30-36. doi:10.1016/j.ijwd.2018.09.004Additional ReadingHanda S, De D, Khullar G, Radotra BD, Sachdeva N.The clinicoaetiological, hormonal and histopathological characteristics of melasma in men.Clin Exp Dermatol. 2018;43(1):36-41. doi:10.1111/ced.13234Lee A-Y.Recent progress in melasma pathogenesis.Pigment Cell Melanoma Res. 2015;28(6):648-660. doi:10.1111/pcmr.12404
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Grimes PE.Melasma: Epidemiology, pathogenesis, clinical presentation, and diagnosis. UpToDate.Handel AC, Miot LDB, Miot HA.Melasma: a clinical and epidemiological review.An Bras Dermatol. 2014;89(5):771-782. doi:10.1590/abd1806-4841.20143063American Academy of Dermatology.Melasma: signs and symptoms.Cestari TF, Dantas LP, Boza JC.Acquired hyperpigmentations.An Bras Dermatol. 2014;89(1):11-25. doi:10.1590/abd1806-4841.20142353Yamaguchi Y, Hearing VJ.Melanocytes and their diseases.Cold Spring Harb Perspect Med. 2014;4(5). doi:10.1101/cshperspect.a017046Ogbechie-Godec OA, Elbuluk N.Melasma: an Up-to-Date Comprehensive Review.Dermatol Ther. 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M.Melasma and thyroid disorders: a systematic review and meta‐analysis.Int J Dermatology. 2019;58(11):1231-1238. doi:10.1111/ijd.14497American Academy of Dermatology.Melasma: causes.Sarkar R, Ailawadi P, Garg S.Melasma in Men: A Review of Clinical, Etiological, and Management Issues.J Clin Aesthet Dermatol. 2018;11(2):53-59.Passeron T, Picardo M.Melasma, a photoaging disorder.Pigment Cell Melanoma Res. 2018;31(4):461-465. doi:10.1111/pcmr.12684American Academy of Dermatology.Melasma: Diagnosis and treatment.Hasegawa K, Fujiwara R, Sato K, et al.Possible Involvement of Keratinocyte Growth Factor in the Persistence of Hyperpigmentation in both Human Facial Solar Lentigines and Melasma.Ann Dermatol. 2015;27(5):626-629. doi:10.5021/ad.2015.27.5.626Plensdorf S, Livieratos M, Dada N.Pigmentation Disorders: Diagnosis and Management.Am Fam Physician. 2017;96(12):797-804.Praetorius C, Sturm RA, Steingrimsson E.Sun‐induced freckling: ephelides and solar lentigines.Pigment Cell Melanoma Res. 2014;27(3):339-350. doi:10.1111/pcmr.12232American Academy of Dermatology.Melasma: Overview.American Academy of Dermatology.Melasma: Self-care.Shankar K, Godse K, Aurangabadkar S, et al.Evidence-based treatment for melasma: expert opinion and a review.Dermatol Ther. 2014;4(2):165-186. doi:10.1007/s13555-014-0064-zGrimes PE, Ijaz S, Nashawati R, Kwak D.New oral and topical approaches for the treatment of melasma.Int J Womens Dermatol. 2019;5(1):30-36. doi:10.1016/j.ijwd.2018.09.004Additional ReadingHanda S, De D, Khullar G, Radotra BD, Sachdeva N.The clinicoaetiological, hormonal and histopathological characteristics of melasma in men.Clin Exp Dermatol. 2018;43(1):36-41. doi:10.1111/ced.13234Lee A-Y.Recent progress in melasma pathogenesis.Pigment Cell Melanoma Res. 2015;28(6):648-660. doi:10.1111/pcmr.12404
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Grimes PE.Melasma: Epidemiology, pathogenesis, clinical presentation, and diagnosis. UpToDate.Handel AC, Miot LDB, Miot HA.Melasma: a clinical and epidemiological review.An Bras Dermatol. 2014;89(5):771-782. doi:10.1590/abd1806-4841.20143063American Academy of Dermatology.Melasma: signs and symptoms.Cestari TF, Dantas LP, Boza JC.Acquired hyperpigmentations.An Bras Dermatol. 2014;89(1):11-25. doi:10.1590/abd1806-4841.20142353Yamaguchi Y, Hearing VJ.Melanocytes and their diseases.Cold Spring Harb Perspect Med. 2014;4(5). doi:10.1101/cshperspect.a017046Ogbechie-Godec OA, Elbuluk N.Melasma: an Up-to-Date Comprehensive Review.Dermatol Ther. 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M.Melasma and thyroid disorders: a systematic review and meta‐analysis.Int J Dermatology. 2019;58(11):1231-1238. doi:10.1111/ijd.14497American Academy of Dermatology.Melasma: causes.Sarkar R, Ailawadi P, Garg S.Melasma in Men: A Review of Clinical, Etiological, and Management Issues.J Clin Aesthet Dermatol. 2018;11(2):53-59.Passeron T, Picardo M.Melasma, a photoaging disorder.Pigment Cell Melanoma Res. 2018;31(4):461-465. doi:10.1111/pcmr.12684American Academy of Dermatology.Melasma: Diagnosis and treatment.Hasegawa K, Fujiwara R, Sato K, et al.Possible Involvement of Keratinocyte Growth Factor in the Persistence of Hyperpigmentation in both Human Facial Solar Lentigines and Melasma.Ann Dermatol. 2015;27(5):626-629. doi:10.5021/ad.2015.27.5.626Plensdorf S, Livieratos M, Dada N.Pigmentation Disorders: Diagnosis and Management.Am Fam Physician. 2017;96(12):797-804.Praetorius C, Sturm RA, Steingrimsson E.Sun‐induced freckling: ephelides and solar lentigines.Pigment Cell Melanoma Res. 2014;27(3):339-350. doi:10.1111/pcmr.12232American Academy of Dermatology.Melasma: Overview.American Academy of Dermatology.Melasma: Self-care.Shankar K, Godse K, Aurangabadkar S, et al.Evidence-based treatment for melasma: expert opinion and a review.Dermatol Ther. 2014;4(2):165-186. doi:10.1007/s13555-014-0064-zGrimes PE, Ijaz S, Nashawati R, Kwak D.New oral and topical approaches for the treatment of melasma.Int J Womens Dermatol. 2019;5(1):30-36. doi:10.1016/j.ijwd.2018.09.004
Grimes PE.Melasma: Epidemiology, pathogenesis, clinical presentation, and diagnosis. UpToDate.
Handel AC, Miot LDB, Miot HA.Melasma: a clinical and epidemiological review.An Bras Dermatol. 2014;89(5):771-782. doi:10.1590/abd1806-4841.20143063
American Academy of Dermatology.Melasma: signs and symptoms.
Cestari TF, Dantas LP, Boza JC.Acquired hyperpigmentations.An Bras Dermatol. 2014;89(1):11-25. doi:10.1590/abd1806-4841.20142353
Yamaguchi Y, Hearing VJ.Melanocytes and their diseases.Cold Spring Harb Perspect Med. 2014;4(5). doi:10.1101/cshperspect.a017046
Ogbechie-Godec OA, Elbuluk N.Melasma: an Up-to-Date Comprehensive Review.Dermatol Ther. 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1
Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M.Melasma and thyroid disorders: a systematic review and meta‐analysis.Int J Dermatology. 2019;58(11):1231-1238. doi:10.1111/ijd.14497
American Academy of Dermatology.Melasma: causes.
Sarkar R, Ailawadi P, Garg S.Melasma in Men: A Review of Clinical, Etiological, and Management Issues.J Clin Aesthet Dermatol. 2018;11(2):53-59.
Passeron T, Picardo M.Melasma, a photoaging disorder.Pigment Cell Melanoma Res. 2018;31(4):461-465. doi:10.1111/pcmr.12684
American Academy of Dermatology.Melasma: Diagnosis and treatment.
Hasegawa K, Fujiwara R, Sato K, et al.Possible Involvement of Keratinocyte Growth Factor in the Persistence of Hyperpigmentation in both Human Facial Solar Lentigines and Melasma.Ann Dermatol. 2015;27(5):626-629. doi:10.5021/ad.2015.27.5.626
Plensdorf S, Livieratos M, Dada N.Pigmentation Disorders: Diagnosis and Management.Am Fam Physician. 2017;96(12):797-804.
Praetorius C, Sturm RA, Steingrimsson E.Sun‐induced freckling: ephelides and solar lentigines.Pigment Cell Melanoma Res. 2014;27(3):339-350. doi:10.1111/pcmr.12232
American Academy of Dermatology.Melasma: Overview.
American Academy of Dermatology.Melasma: Self-care.
Shankar K, Godse K, Aurangabadkar S, et al.Evidence-based treatment for melasma: expert opinion and a review.Dermatol Ther. 2014;4(2):165-186. doi:10.1007/s13555-014-0064-z
Grimes PE, Ijaz S, Nashawati R, Kwak D.New oral and topical approaches for the treatment of melasma.Int J Womens Dermatol. 2019;5(1):30-36. doi:10.1016/j.ijwd.2018.09.004
Handa S, De D, Khullar G, Radotra BD, Sachdeva N.The clinicoaetiological, hormonal and histopathological characteristics of melasma in men.Clin Exp Dermatol. 2018;43(1):36-41. doi:10.1111/ced.13234Lee A-Y.Recent progress in melasma pathogenesis.Pigment Cell Melanoma Res. 2015;28(6):648-660. doi:10.1111/pcmr.12404
Handa S, De D, Khullar G, Radotra BD, Sachdeva N.The clinicoaetiological, hormonal and histopathological characteristics of melasma in men.Clin Exp Dermatol. 2018;43(1):36-41. doi:10.1111/ced.13234
Lee A-Y.Recent progress in melasma pathogenesis.Pigment Cell Melanoma Res. 2015;28(6):648-660. doi:10.1111/pcmr.12404
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