Melasma – Causes, Symptoms, Pictures, Treatment

Melasma is change in skin color that occurs commonly in women during their reproductive years. Brown tanned skin is seen on the upper lip, upper cheeks and forehead of women belonging to age group of 20-50 years. It is caused by change in hormones and using oral contraceptive pills and during pregnancy. Most of these women would have been exposed to harsh ultraviolet rays of sun earlier. Melasma is commonly seen in many pregnant women belonging to Asia and Latin America. People with dark complexion have increased chance of developing melasma patches. Among the total figure of 50 million people affected with melasma more than 90% are women. Using sunscreen lotion and creams can help to remove melasmic patches from your skin.

Melasma Causes

  •  What exactly triggers melasma is not known, but it is believed to be influenced by several factors.
  •  Majority of women get melasma patches during pregnancy (hormonal changes), using oral contraceptive pills and undergoing hormone replacement therapy.
  •  If you have a family history of melasma or using powerful epilepsy medications for long or if you belong to particular race or if your skin is overly exposed to UV rays of the sun you may develop melasma.
  •  Mutated genes can also cause this condition.
  •  Dark patches of melasma are formed when the skin is exposed to sunlight for long. The patches are more in summer months than in winter and color changes of the skin is clearly visible.
  •  Pregnant women getting melasma is known as chloasma. There will be increased production of estrogen and progesterone in pregnant women which will trigger the patches of melasma on the skin.
  •  Women who are in the postmenopausal stage will undergo estrogen replacement therapy can also develop melasma.
  • On the whole, melasma is caused mostly by sun and partly by genetic predisposition.


Melasma is marked by hyper-pigmentation or discoloration of the skin on your face. It can develop on the center of the face (centrofacial type) or on the cheekbones (malar type) or on the jawbone (called as mandibular). The affected area will be discolored and look blackish brown and dark different from the original skin color. In rare cases neck portion is affected by melasma and sometimes other parts of the body like forearms and hands are also affected. Apart from color change of the skin, melasma is harmless and does not cause any other symptoms like irritation or itching of skin.

Types :

Melanin is the pigment responsible for skin color. Based on the content of melanin melasma is categorized into 4 types. Epidermal melasma is one which there is excess of melanin pigment in the epidermis layer (superficial) of the skin. Dermal melasma is characterized by special cells called melanophages which is seen throughout the dermis layer of the skin. Mixed type is one in which symptoms of both epidermal and dermal melasma are seen. Fourth type (unnamed) is seen developing on dark complexioned people largely.

Tests and Diagnoses :

Melasma can be identified easily by physical examination of affected skin. It leaves dark brown colored patches on your face. Visual examination is enough for confirming melasma. Very often mixed type of melasma is seen affecting the epidermis and dermal layer of the skin causing discoloration on the face.


Very effective treatment for melasma patches is to apply creams that contain 2% of hydroquinone. It is available over the counter in the brand names of Porcelana and Esoterica. Your doctor may give prescription creams like Glyquin, Obagi clear or Tri Luma. Generally if you want to get hydroquinone concentration more than 2% you may require a valid prescription. You need to apply the cream on the dark brown patches twice or thrice a day. In case you are planning to go out in the hot sun, you should apply sunscreen lotion that contains SPF (sunscreen protection factor) of more than 30%.

Treatments are the same for all types of melasma but the above creams will respond well for the epidermal type of melasma. For many women, no creams are required for managing melasma since it will disappear after some months. Women who develop melasma patches during pregnancy stage will find these patches completely disappearing after delivering the child. Similarly women using birth control pills will find all the melasma patches resolving without any treatment after they discontinue the pills.

For severe cases of melasma your doctor will prescribe creams that contain high concentration of hydroquinone or combination of HQ with tretinoin or corticosteroids. Drugs like retinoic acid, tazarotene, glycolic acid or lactic acid mixed with HQ. All these medications can cause adverse effect like skin irritation temporarily. Ochronosis is a condition that causes permanent skin discoloration for women using HQ for prolonged period. Chemical peeling, micro dermabrasion and laser treatment are some other methods used for treating melasma.

In chemical peeling method the strength of the chemical to be used will be decided by your doctor based on the intensity of dark patches of melasma. He would administer various combinations of chemicals mixed with HQ for effective resolution. In micro dermabrasion method, vacuum suction is done along with exfoliation of top layers like aluminum oxide or diamond chips. Your doctor will adjust the vacuum pressure based on the intensity of patches and your capacity of tolerance.

In any type of treatment method, you cannot expect dramatic results and you need to undergo several sessions for getting positive results. Further you have to continue using sunscreen creams along with this method. You have to discuss with your doctor about the possible outcomes before spending for the procedure. Since all these methods of treatments are cosmetic you may not get coverage by your insurance providers. Laser therapy is not the recommended option for treating melasma. It may worsen the symptoms and hence you need to select the right method of treatment with caution.

Some doctors use azelaic acid for treating melasma which is a product that does not contain HQ. Azelaic acid 15-20% is effective in treating melasma without any major side effects. Similarly Tretinoin, Renova are some other non-hydroquinone products for getting good results. You need to use sunscreen formula that contains SPF factor of 30 or above along with hydroquinone for getting effective results. Make sure that you are using sunscreen lotions regularly while going out.

Pictures of Melasma

Images, Pics, Photos and Pictures of Melasma

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Prevention :

It is difficult to prevent melasma particularly if you are genetically inheriting it or your work involves more of sun’s exposure. If you have family history of melasma then you need to doubly precautious in protecting your skin from the harsh UV rays of the sun. Use sunglasses, hats and sunscreen lotions for effective protection of your skin.

Outlook :

Melasma is not a disease and anyone who gets dark brown patches will not develop it overnight. You should remember that melasma develops very slowly and not by overnight and hence it takes time for its resolution. You cannot expect speedy results shortly after the treatment. You should be patient using the right formula creams for long time for getting the best result.

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