Melasma is a skin issue that appears as dark patches and develops on the bridge of the nose, the forehead, the cheeks, and the upper lips on the face. 

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Table of content

Causes of Melasma

The most common cause of these patches is exposure to sunlight. Any consumption of medicines or applications of topical creams that are photosensitizing can increase the risk of developing these colored patches.

Other common causes of melasma include:

  • Certain cosmetics

  • Medications used to treat ovarian and thyroid problems

  • Hormonal birth control

  • Hormone replacement medications

  • Genetic predisposition

  • Overproduction of melanocyte-stimulating hormones

  • Allergic reactions

  • Sun exposure

Some cosmetics or medications used to treat ovarian and thyroid problems can also cause melasma, so you may want to check with your doctor if you’re taking these medications and noticing discoloration.

Women with light brown skin living in regions with exposure to excessive sunlight are also at a higher risk of developing this condition.

Any thyroid malfunction that leads to overproduction of melanocyte-stimulating hormone and allergic reactions to medications and cosmetics can also lead to developing melasma. 

Some studies have even suggested that not having a basic skincare routine that includes a moisturizer with SPF can increase your chances of needing melasma treatment later in life.  

Symptoms of Melasma

The symptoms of melasma include:

  • Dark, irregular but well-demarcated macules or skin patches, varying in size from 0.5 cm to 10 cm

  • Centro facial, malar, or mandibular patches

  • Darker skin over time

  • No pain, itching, or burning sensation.

Melasma Risk Factors & Complications:

Melasma is a condition that is more common in women than in men. Yet, there are a wide variety of other risk factors that increase the likelihood of developing melasma in one’s lifetime. 

The most common risk factors of melasma include:

  • Pregnancy

  • Skin problems like eczema

  • Gender

  • Family history of melasma

  • Hispanic individuals, Africans and Central Asians

  • Fitzpatrick skin type IV to VI

  • Estrogen dominance and other hormonal imbalances

  • Birth control pills 

  • Sun and ultraviolet light exposure

  • History of certain medications

  • History of thyroid dysfunction

  • Stress, as it can trigger overproduction of MSH


One of the most common causes of melasma is pregnancy. Pregnant women are so much more likely to develop this condition, melasma’s nickname is, ‘the mask of pregnancy.’ 

Family Medical History

Your family members can offer insight into the likelihood that you’ll suffer from melasma during your lifetime. Since melasma is genetic, you may likely have another family member that suffers from this condition. If your family members suffer from any of the above conditions, you’re also more likely to get melasma.


People of Hispanic, African, and Central Asian descent are more likely to develop melasma — especially those living in sunny climates. 

Hormone Imbalances

Hormone imbalances often cause melasma (which is partially why pregnant women suffer so often from this condition). People taking certain hormone medications, hormonal birth control, or imbalanced hormones may develop melasma.

Certain Medications

The side effect of some medications is melasma. Talk to your doctor if you’re on any medications for ovarian or thyroid issues.


While stress doesn’t cause melasma per se, it can exacerbate the condition and lead to more frequent breakouts. If you suffer from this condition as well as any of the above conditions, you may want to reduce your stress levels to manage your symptoms. 

Melasma Complications

There are no major complications associated with this condition. For the most part, it’s simply cosmetic.

If not treated, the patches can be permanent. Again, this shouldn’t negatively affect your health. Yet, some people that suffer from melasma feel frightened or ashamed after developing the condition.

Some cultures may also shun these people, accusing them of trying to lighten their skin. Others may simply be scared that someone with melasma has a contagious disease. 

Developing melasma may not hurt your physical health, but it may hurt your emotional health. In addition to treating the melasma itself, we recommend chatting with an online therapist like those on Talkspace’s platform to work through any negative feelings associated with this condition. 

Diagnosis of Melasma:

The good news is that it’s pretty easy to diagnose melasma. There is no invasive diagnosis (usually). A doctor or dermatologist must just simply perform a visual examination. 

The two most common ways to diagnose melasma are via Wood Lamps’ examination and a skin biopsy. 

Wood Lamps’ Examination

This lamp illuminated Ultraviolet light that helps in getting a clear view of the patches’ pattern, sun damage, and layers of the manifestation that cannot be seen otherwise. It also helps to identify if there is any bacterial or fungal infection present.

Skin Biopsy

Skin biopsies take a small portion of the skin. It is assessed for any underlying disease like Addison’s disease, maturational dyschromia, lupus, or any skin cancer. 

Treatment of Melasma

Treating melasma is relatively easy if addressed quickly. You should always go to a doctor or dermatologist to get diagnosed with melasma, as you’ll also get tested for other related conditions, like melanoma. 

Some dermatologists may recommend prevention and/or lifestyle changes to help prevent melanoma in the future, such as sun protection.

Other doctors may recommend over-the-counter lightening lotions, skincare regimens, bleaching, dermabrasion, or hormonal progesterone treatments. If your dermis doesn’t clear up after these treatments, your melasma may be permanent. 

Companies like Rory and Musely offer prescription skincare products to treat melasma. Chat with a dermatologist online and get a personalized skincare regimen. Melasma treatment is a great way to combat the signs of aging so that you and your skin shine bright like the diamond you are.  

In Pregnancy, melasma goes away and clears off by the end of the gestation period and birth of the baby. 

Melasma is a side-effect of hormonal medications. Women who take oral contraceptives or hormone replacement therapy often see the patches fade once they stop taking the medications. This is because the imbalance in hormones is restored. 

A few other ways by which the patches or pigmentation can fade off are:

  • Hydroquinone

  • Tretinoin

  • Azelaic acid cream

  • Topical steroids

  • Chemical peels


Hydroquinone is a topical cream that reduces and almost removes the pigmentation from the skin. It inhibits the chemical processes that cause or direct the production of melanin, the pigment responsible for making the skin dark. 


Tretinoin is a type of vitamin A that stimulates peeling off dead skin and promotes new skin formation. This causes the patches to fade gradually, and the skin becomes clear once all the patches are shed. 

Azelaic Acid Cream

Azelaic acid cream appears to work by slowing down or stopping the production of pigment, the substance that makes the skin darker.

Topical Steroids

The application of other topical steroids can lighten up the skin color.

Chemical peels

Chemical peels are chemical liquid solutions applied on a patch of the skin to cause a mild chemical burn that resembles a sunburn. 

With time, these burned layers peel off, leaving fresh and new skin. Examples of such chemicals are glycolic acid, which is the mildest of all three options and has fewer chances of skin scarring. 

Other chemical solutions are mostly Phenols, trichloroacetic acid (TCA), and alpha hydroxy acids (AHAs). Depending on the severity of the patches and the color of your skin lesions, you may want to choose a harsher chemical peel. 

Types of Chemical Peels

Mild peels are the least severe form of chemical peeling. This method uses solutions containing alpha-hydroxy acids. Usually, the procedure lasts for 10-to-20 minutes, and pain is minimal. Recovery times can take up to six days.

Medium peels use trichloroacetic acid. This is severe when compared to mild peels, so recovery times are longer. There can be visible signs of the peel, such as redness of the skin and swelling; however, these signs disappear with time, and the results last longer. 

Deep peels often make use of phenols. They cause skin burns and should be used with care. 

Deep peels penetrate deep into your skin, and the effects last longer than mild or medium peels. The pain associated with deep peels is also severe. Most dermatologists only suggest a deep peel as a last resort. 

Other treatments for melasma include:

  • Intense pulsed light therapy 

  • Laser treatments

  • Microdermabrasion

Intense pulsed light therapy utilizes certain wavelengths of light to target and removes pigmented areas of skin.

Doctors may also use laser treatments to safely remove spots associated with melasma.

Microdermabrasion is a painless cosmetic procedure where the skin’s outermost layer is exfoliated and leaves the skin soft and glowing.

Patients don’t even need to take painkillers before undergoing the above treatments, as these treatments are generally painless. 

Prevention of Melasma

If your family is prone to melasma, you’re pregnant, or you suffer from conditions related to melasma, we recommend the following ways to prevent dark spots:

  • Cover your sun-exposed areas such as cheeks, forehead, and lips every time you walk out in the sun

  • Apply sunscreen with SPF 30 or more every day

  • Wear sun protection, such as a hat, for outdoor activities 

  • Avoid sunbathing during pregnancy

  • Avoid UVB light and visible light

  • Use skin treatments, like Musely’s skincare regimen

  • Avoid scrubbing as it may irritate the skin

Melasma is mostly treated by topical application, skin therapies, and practicing good skin hygiene. This condition has a high chance of recurrence, so we recommend following the above prevention strategies and making an appointment with an online dermatologist like Musely if to treat melasma as soon as it appears.