Hyperpigmentation: melasma What causes melasma and how can I reduce dark patches on my skin?

Melasma is a type of hyperpigmentation that is common in women, especially during and after pregnancy. It normally appears as large dark patches on the face although other parts of the body can be affected. This article looks at what causes melasma and explains some steps you can take to help reduce the appearance of dark patches on your skin.

What is melasma and what causes it?

Melasma, also known as chloasma, is a form of hyperpigmentation that appears on the face, especially on the cheeks, bridge of the nose, forehead and upper lip and sometimes on other sun-exposed parts of the body, such as the forearms. Men can experience melasma, but it is much more common in women.

Melanin is the pigment that defines the color of a person’s skin, and melasma is caused by an increase in melanin production. This increase is thought to be triggered by changes in hormone levels, especially those caused by pregnancy and oral contraceptives, as well as by the sun.

Melasma is not in any way harmful but can cause distress when it is very noticeable.

Melasma: melasma on face — Melasma is a form of hyperpigmentation which causes dark patches on the skin

Melasma and pregnancy

Between 10–15 percent of pregnant women experience melasma1 and the condition is sometimes referred to as “the mask of pregnancy”.

During pregnancy endogenous hormones (meaning the hormones that are produced naturally within the body) stimulate the melanocytes (the melanin producing cells located in the basal layer of the epidermis) causing them to produce more melanin.

The International Dermal Institute, Melasma Unmasked by Dr Claudia Aguirre quoting Kang, H. Y., & Ortonne, J. P. (2010). What should be considered in treatment of melasma. Annals of Dermatology, 22(4), 373–378.

Melasma from pregnancy — During pregnancy endogenous hormones stimulate the production of melanin pigments

Melasma and oral contraceptives

Between 10–25 percent of women taking oral contraceptives¹ experience melasma. Women who take birth control pills undergo similar kinds of hormonal changes as those that occur during pregnancy. Unlike age spots, melasma can disappear of its own accord after birth or if estrogen intake is reduced.

The International Dermal Institute, Melasma Unmasked by Dr Claudia Aguirre quoting Kang, H. Y., & Ortonne, J. P. (2010). What should be considered in treatment of melasma. Annals of Dermatology, 22(4), 373-378.

Melasma causes: melasma skin — Hormones can stimulate melanocytes (the melanin producing cells) and trigger melasma (Schematic illustration)

The sun is a major contributor to, and aggravator of, the development of melasma and other factors such as family predisposition, age and certain anti-epilepsy drugs can also play a role.

There are three types of melasma:

Epidermal melasma affects the top layer of skin and the hyperpigmentation is brown with well-defined borders.
Dermal melasma affects the deeper dermal layers of skin and is characterized by blue-gray patches.
Mixed melasma (a combination of epidermal and dermal) shows as a brown-gray pigment.

You can read more about what causes hyperpigmentation in general and find out more about the different types of the condition in Hyperpigmentation: what causes dark spots and how can I reduce them?

Melasma and age spots are harmless. Melanoma (a type of skin cancer) can be life-threatening. If you have any concerns about your pigment spots – if they change shape, size and color or if they become itchy and start to bleed – it’s important that you consult your doctor.

What can I do to help prevent dark patches from forming?

A sensible attitude to sun protection is the most significant step you can take to helping to prevent or reduce the severity of melasma. Limit the time you spend in the sun, keep out of the sun during its most intense hours and wear protective clothing and sunhats whenever possible. This is particularly important if you have a genetic disposition to melasma (i.e. it runs in your family) or if you are pregnant, on the pill or taking another form of hormone supplement.

Sun protection is not just for sunbathers. The sun’s rays effect skin even on cloudy days, so give your skin the daily protection it needs. As well as reducing hyperpigmentation, Eucerin Anti-Pigment Day SPF 30 offers effective UVA and UVB (SPF 30) protection and prevents the formation of additional sun-induced pigment spots. If you’re going to be spending time in the sun choose a high or very high factor sun protection product which has been specially formulated for your skin type and condition and reapply it regularly. You can find out more about the Eucerin range of superior sun protection products here.

Melasma treatment: sun protection — Sun protection is the most significant step you can take to help prevent or reduce instances of melasma

How can I remove or reduce melasma?

Dermatological treatments such as chemical peels and laser therapy can help to reduce melasma. Epidermal melasma is the easiest type to reduce but, due to the depth of the melanin pigments in dermal and mixed melasma, these types can be harder to treat.

Chemical peels involve applying a chemical solution (such as an AHA) to exfoliate skin (remove dead skin cells), stimulate the growth of new skin cells and reveal new skin. Read more about chemical peels in What are chemical peels and how do they work?
Laser therapy has a similar effect but tends to be more precise as the dermatologist has more control over the intensity of the treatment. Laser treatments involve ‘zapping’ the affected areas with high-energy light. The mildest treatments work on the skin’s epidermis (surface layer), while more intense treatments can penetrate the deepest layers of the skin. Find out more in Laser therapy: how should I care for my skin after treatment?

Melasma treatment laser — Laser therapy can help to reduce the appearance of melasma

Melasma how to treat: chemical peel — Chemical peels exfoliate skin to reveal new skin beneath

Dermatologists may also prescribe and/or use hydroquinone which is still regarded as the most effective topical agent for reducing hyperpigmentation. It can, however, only be used for limited periods of time because, like other forms of chemical peel and laser treatment, it can irritate skin and actually cause post-inflammatory hyperpigmentation, especially in people with darker skin.