Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Melasmabrown facial patches from hormones and sun
Melasma is a common dark discolouration of the facial skin. The patches are not dangerous and cause no symptoms, but are often experienced as bothersome. Read here how melasma develops and what can be done.
What is melasma?
Melasma is a dark discolouration of the facial skin, in the form of brown, irregular patches. The discolouration is benign and painless. Because melasma often appears during pregnancy, it is also called the pregnancy mask. An older name is chloasma.
What causes melasma?
The exact cause is unknown. In melasma the pigment cells produce too much pigment, and not all equally: that is how patches form. Hormones play an important role. Female hormones can drive pigment production, which is why melasma often appears during pregnancy and can also be triggered by the contraceptive pill. Sunlight (UV) clearly worsens the patches. Sometimes cosmetics or certain medicines trigger melasma, and heredity can play a part. In some people no trigger can be identified.
How do you recognise melasma?
Brown, irregular patches on the face: mainly on the forehead, the cheeks and cheekbones, the temples, around the eyes and on the upper lip. Melasma occurs almost always in women and is only rarely seen in men.
How is the diagnosis made?
A dermatologist usually recognises melasma at a glance. Additional tests, such as a biopsy, are usually not needed.
What is the treatment?
The first step is avoiding the triggers, especially sun. In addition, treatment can aim to reduce the pigment. The pigment can sit superficially or deeper in the skin; deeper pigment is harder to treat.
Bleaching creams. These slow down pigment production. Hydroquinone is the best-known bleaching agent; tretinoin and azelaic acid are also used, sometimes combined. The effect appears after 4 to 8 weeks. A possible side effect is skin irritation, which can actually worsen the discolouration.
Chemical peel with fruit acids. The skin flakes off, which aims to carry away the excess pigment.
Laser therapy. The laser can destroy superficial pigment. The effect varies per person: it can help, but can also worsen the patches. That is why a test patch is often treated first.
Camouflage therapy. A special covering cream can make the patches nearly invisible. A skin therapist can show you how to apply the cream and which shade fits.
What can you do yourself?
During UV exposure, apply sunscreen with factor 50 to the face and neck every 2 hours. Do not use the tanning bed. Avoid medicines that can trigger or worsen melasma; discuss this with your doctor.
Frequently asked questions about melasma
Is melasma dangerous?
No. Melasma is benign and causes no symptoms. The patches are mainly experienced as cosmetically bothersome.
Is melasma caused by the pill?
Hormones play an important role. The contraceptive pill contains hormones and can trigger melasma, just like pregnancy.
Does melasma go away on its own?
After the menopause the pigment often fades by itself. After treatment the patches can return, especially after sun exposure.
Does sunscreen help against melasma?
Sunlight clearly worsens melasma. Protection is therefore the basis: during UV exposure apply factor 50 every 2 hours, and do not use the tanning bed.
Sources and more information
- NVDV patient leaflet Melasma (nvdv.nl)