Hyperpigmentation: What is melasma – Causes, symptoms and treatment for the ‘mask of pregnancy’

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.

Melasma derives from the Greek word for black ('melas'), and it's also referred to as chloasma, as 'cholas' is Greek for green-ish, in pregnant women. This article looks at what causes melasma and how you can reduce the appearance of dark patches on your skin.

Melasma, is a form of hyperpigmentation that appears on the skin. Some of the most commonly affected areas include:

• Face, especially on the cheeks
• Bridge of the nose
• Forehead
• Upper lip
• Other sun-exposed parts of the body, such as the forearms or neck, but this is less common

The condition is not in any way harmful or contagious, but it can cause distress or embarrassment in cases where it's very noticeable.

Men can experience melasma, but it is much more common in women, with an onset usually between the ages of 20 and 40. Chloasma is common during pregnancy, when up to 50% of women may be affected.

It is more common in people who tan easily, or have naturally darker skin. Melasma is less common in people with fair skin. It typically becomes more visible during the summer, while it improves over the winter months. Though melasma is more common in people with a family history of the condition, it is not thought to be hereditary.

Between 10–15 percent of pregnant women experience chloasma¹ 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.

1.  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. 

Doctors aren't sure of the exact cause of melasma, but it is thought to develop as a result of pigment-producing cells in the skin (melanocytes) producing too much pigment (melanin).

There are several factors that are associated with the condition, including changes in hormones during pregnancy (chloasma), birth control pills, estrogen and progesterone sensitivity. Sun exposure, stress and thyroid disease are also regarded as causes of melasma.

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.

1. 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.

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 characterised by blue-grey patches.
• Mixed melasma (a combination of epidermal and dermal) shows as a brown-grey 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 and will not develop into skin cancer. 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 colour or if they become itchy and start to bleed – it’s important that you consult your doctor.

At present there is no cure for melasma, but there are several treatments to improve the skin's appearance. Chloasma may go away a few months after giving birth, though it can come back during another pregnancy.

A combination of measures is generally required for melasma treatment. Year-round, lifelong 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. Also, discontinue hormonal contraception if possible.

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.

Before spending time in the sun choose a high or very high factor sun protection product which has been specially formulated for your skin type. Ensure you reapply it regularly. Explore the Eucerin range of superior sun protection products here.

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?

Dermatologists may also prescribe and/or use hydroquinone which is still regarded as the most effective topical agent for reducing hyperpigmentation. Hydroquinone is available as a lotion, cream, or gel, and is applied directly to the discoloured patches of skin. 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.

Dermo-cosmetic skincare products can be used daily to help to extend the results of dermatological treatments. All four products in the Eucerin Anti-Pigment range – a day cream, a night cream, a dual action serum and a spot corrector can be used as a melasma cream. They contain Thiamidol, an effective and patented ingredient that acts at the root cause of hyperpigmentation by reducing melanin production (maximum four applications of Thiamidol per day). It has been clinically and dermatologically proven to reduce dark spots and prevent their re-appearance. The Dual Serum now comes in a mono-chamber pack to make application even easier, with the same proven efficacy in the formula.