Melasma is a common skin problem that shows up as brown or grayish-brown patches on the face, often on the cheeks, nose, forehead, chin, and above the upper lip. Women as significantly more likely than men to get melasma, and it is especially common during pregnancy due to hormone influences. The areas that darken in color do not itch or sting. People with naturally darker skin tones, such as those of Hispanic, North African, African American, Native American, Asian, Indian, Middle Eastern, or Mediterranean descent are more likely to get it than people with more fair skin. Darkening of the skin in this condition worsens with sun exposure due to UV radiation, and it can be triggered by changes in hormones, birth control and hormone replacement medication, or by certain skin care products that irritate the skin.
Melasma is usually diagnosed by a dermatologist based on visual examination. Sometimes a small skin biopsy may be necessary to rule out a different type of skin condition that can look similar. The hyperpigmentation may fade on its own, but often it may persist and be difficult to treat. Your dermatologist may use one or a combination of more than one treatment. The most important treatment for melasma includes sun protection: wearing SPF 50+ broad spectrum sunscreen every day and reapplying every 2 hours. Wearing a broad-brimmed hat and avoiding direct sun whenever possible are also very important. Other treatments your dermatologist may prescribe include:
- Tretinoin: topical retinoid
- Hydroquinone: 2 or 4% or sometimes stronger. This cream lightens skin.
- Corticosteroid cream
- Tri-Luma (triple cream): fluocinolone/tretinoin/hydroquinone combination
- Azelaic acid (Finacea) or kojic acid
- Chemical peel or microdermabrasion: only your dermatologist should perform these procedures since there is risk that these may worsen melasma
Melasma may be stubborn and difficult to treat, but under a dermatologist’s care many people have a good outcome with treatment. Successful treatment often takes many months and is intended to be gradual to avoid negative side effects. Maintenance therapy and sun protection is often necessary to prevent recurrence.