What Is Melasma?
Melasma is a skin condition with brown, blue, or freckle spots that form what is often called “the mask of pregnancy.” It’s a dark, mask-like mark that is common, painless, and typically goes away after a few months. This doesn’t mean it’s not bothersome while there.
Melasma vs. hyperpigmentation
Your skin cells make a substance called melanin, which gives it its color. The darker your skin (or the easier you tan), the more melanin you have. If these cells are unhealthy, they can make too much melanin. This can lead to areas on your skin that look darker than the rest. When this happens, it’s called hyperpigmentation.
Darker patches on your face or neck can be a sign of melasma.
You’ll need a doctor to help you find out if it’s melasma or something else. Hyperpigmentation on your skin might be due to something else like:
- Sun exposure
- Medical conditions like Cushing’s disease
- Rashes
- Hormonal changes
- Blue light from screens and electronic devices
- Adrenal disorders (when your body doesn’t make enough cortisol hormone)
- Genetics – a family with freckles
- Lack of vitamin D
- Thyroid disorders
Melasma Causes
Pregnant women are most at risk of melasma due to an increase in hormones. The dark spots are often called “the mask of pregnancy” because of its appearance over the face or neck. Melasma can affect people other than pregnant women, but women are 90% more likely to experience it than men.
More research is needed, but other triggers appear to be heavy exposure to sunlight, tanning beds, stress, medications for seizures, birth control pills, and thyroid disease.
You are more likely to get melasma if:
- You are a woman aged 20 to 40.
- You have a darker skin tone.
- A relative has had melasma.
Melasma in Pregnancy
Melasma is a common skin disorder in pregnant women with darker skin. About 15% to 50% of pregnant women get it. Experts believe an increase in the hormones estrogen and progesterone can trigger melasma. It seems to be more common in the second or third trimester.
Up to 33% of the general public can get melasma, but it often occurs during a woman’s reproductive years.
Melasma Symptoms
The signs of melasma are very noticeable. It causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. The patches might also be red or inflamed. Melasma commonly shows up in six places or a combination of sites on your skin:
- Brachial: On your shoulders and upper arms
- Centrofacial: Forehead, cheeks, nose, and upper lip
- Lateral cheek pattern: Both cheeks
- Malar: Cheeks and nose
- Mandibular: On your jawline
- Neck: In people over the age of 50, melasma on all sides of the neck
Where Else Does It Show Up?
You may see it show up on your cheeks, nose, chin, above your upper lip, or on your forehead. Sometimes you can see it in other places like your arms, neck, or back. While it is more common in these areas, melasma can show up anywhere on the body that is exposed to the sun. This is why symptoms can increase during the summer.
Melasma Types
Melasma presents in one of three ways. The type has to do with the darkness of the color, the shape of the border, and how well it responds to treatment. A black light is used to test this.
Epidermal melasma: This affects the top layer of your skin, known as the epidermis. Usually the patches appear on your face and are dark brown in color and the shape is relatively uniform.
Dermal melasma: This type of melasma affects the deeper layer of your skin called the dermis. It is usually bluish-gray or grayish brown and it has a blurry border. Because this melasma is deeper in the skin, your dermatologist may use treatments such as laser therapy or microneedling.
Mixed melasma: This is the most common type of melasma. It’s a combination of epidermal and dermal melasma. The patches can appear as a mixture of brown, gray, and bluish gray colors. Your dermatologist may use a combination of treatments, including topical creams, chemical peels, laser therapy, and microneedling.
Melasma Diagnosis
Your primary doctor may suggest you see a dermatologist (a doctor trained in conditions of the skin, hair, and nails) to confirm a diagnosis.
Your doctor will examine your skin using a Wood’s lamp (a black light) to look at any color changes to your skin. To rule out other conditions and determine if you have melasma, they may order a biopsy. For a biopsy, a small piece of your skin will be removed and examined. It is a safe and quick procedure commonly used to diagnose skin conditions.
If you have melasma (versus another skin condition), your biopsy results will show certain shapes.
Doctors may use something called the Melasma Area Severity Index (MASI) to see how severe your condition is and how to approach treatment.
Your doctor may also ask questions to diagnose your melasma. Take notes before your appointment to prepare.
- When did you see a darker color on your skin?
- Where are the dark patches on your body?
- Do you have a family history of melasma?
- Are you pregnant?
- What soaps do you use?
- What type of makeup do you use? Other products on your skin?
- Have you been diagnosed with any other skin conditions?
- What type of treatment are you open to? Medications? Procedures? Both?
It is important to talk to your doctor to make sure you receive the right diagnosis. Dark patches (those similar to melasma) can be birthmarks (nevus of Ota, nevus of Hori), a result of light sensitivity, overuse of skin-lightening creams, reactions to drugs or foods, or even skin conditions that have no known cause.
Melasma Treatment
Medications, creams, and injections
Depending on the type of melasma, it may be treated with topical creams to stop the formation of new dark patches. These types of topical treatments are called tyrosinase inhibitors. Treatments for melasma may be in the form of a cream, injection, or oral medication.
- Azelaic acid: A cream, lotion, or gel applied twice daily; safe for pregnant women.
- Cysteamine: Some studies show it can be an effective treatment.
- Hydrocortisone: This helps fade the dark color caused by melasma, and it may help remove the risk of dermatitis caused by other medications.
- Hydroquinone: A cream or lotion applied directly on the melasma patches at night for 2-4 months.
- Methimazole: An antithyroid cream or tablet that may be helpful if hydroquinone doesn't help.
- Soybean extract: Studies show this might reduce the color caused by damaged skin cells.
- Topical alpha-hydroxy acid: Water-soluble acids that slough off dead skin cells; also known as a chemical peel that removes the first layer of the skin; available at most medical spas.
- Tranexamic acid: A cream, injection, or oral medication commonly used for heavy menstrual bleeding, but some studies show it can help melasma patients.
- Tretinoin: A topical retinol (vitamin A) often used to treat acne. It works by replacing old skin cells with newer ones, but it can cause dermatitis and is not safe if you’re pregnant.
Dermatitis (a skin condition that may cause irritation or swelling) is a side effect of certain melasma medications. Some creams and lotions for your skin may sting or cause an allergic reaction, so be sure to discuss options with your doctor.
Some medications may cause other side effects like headaches, hair shedding, abdominal pain, bloating, nausea, or vomiting. If you notice any unusual symptoms after taking medication, contact your doctor right away.
Procedures
If medication or topical treatments aren’t working for you, they aren’t your only option. Your dermatologist can perform procedures that may help your melasma.
- Light therapy: This is intense light or types of laser therapy. While too much sun or light from electronics can cause melasma, light can also be an effective way to reduce or erase discoloration in your skin.
- Chemical peel: You may have gotten a peel at a day spa. Your doctor can also do one to help peel (remove) damaged skin to allow new, smoother, even-toned skin to appear.
- Microneedling: This procedure involves very small tears in your skin. As your skin heals, it can do so with an even skin tone.
- Platelet-rich plasma: This involves taking a small amount of your own blood, putting it in a machine that processes it, and then injecting it back into your body and can help even skin tone. This type of therapy is used with other conditions like sports injuries and hair loss.
Living With Melasma
Going through life with a noticeable skin condition may not be easy. Experts note there may be a strain on your mental health. Psychologists now suggest a connection between skin disorders and emotional distress. A new form of psychology called psychodermatology helps you manage the stress of having a visible medical condition.
In some cases, experts say managing mental and emotional health may also benefit the skin.
If you find it difficult to live successfully with melasma, contact your doctor or a therapist to help you find tools to cope.
Melasma Diet or Skin-Healthy Diet
More research is needed to learn how foods may impact melasma. At this time, doctors don’t know if certain foods cause it, make it worse or better, or have no effect.
Some foods will help your skin stay healthy. Mostly, foods high in vitamin D will do the trick. You don’t have to stick to only milk, especially if you are lactose intolerant. Try these other options for vitamin D:
- Almond milk
- Eggs
- Meat
- Mushrooms
- Tuna
- Oily fish like salmon
- Orange juice
- Yogurt
If your vitamin D levels are still low, talk to your doctor about prescription or over-the-counter vitamin D supplements.
Takeaways
Melasma is a skin condition common in pregnant women, but others can get it too.
It includes dark brown or grayish patches, mostly on your neck or face.
Melasma can mimic other skin conditions, so check with your doctor to be sure. Doctors use your medical history, a black light, and possibly a biopsy to diagnose melasma.
Treatments like topical creams and ointments, light therapy, or chemical peels may help.
You can take control by eating a skin-healthy diet, managing stress, and forming a strong partnership with your health care team.
Melasma FAQs
What are the main causes of melasma?
The two main triggers for melasma are hormonal changes, such as those occurring during pregnancy, and excessive exposure to sunlight or light from electronic devices.
How do you get rid of melasma?
There is no cure for melasma, but it can be controlled with a range of treatment options from creams and ointments to laser therapy or chemical peels. For some forms of melasma, it may go away on its own or as you age.
Does melasma ever go away?
Melasma can go away on its own as you get older. Or with treatment or lifestyle changes, some forms of melasma may go away.
What deficiency causes melasma?
Some studies suggest anemia (an iron deficiency) might contribute to melasma.
What hormone imbalance causes melasma?
A rise in hormones estrogen and progesterone can trigger melasma. This is why pregnant women, who have extra of both hormones, are more at risk.
How to remove melasma naturally?
Make sure you follow a few skin self-care tips to help your skin look and feel its best.
- Protect your skin from the sun. Wear 30 SPF (minimum), wear wide-brim hats and sunglasses, and look for the shade. Don’t forget to reapply sunscreen every 15 mins or so while outside. If you have darker skin, try a tinted sunscreen since any visible light might impact your melasma.
- Choose skin care products carefully. Anything that makes you itchy or irritated is not a skin friend. Irritation can even darken spots on your skin.
- Wear makeup if you please. Melasma can be hard to navigate if you get stares or people feel sad for you. As you work with your doctor to find the right treatment plan and take steps to improve your diet, there are special forms of makeup that can hide or disguise dark spots caused by melasma.
