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Common Sites on the Face for Melasma  
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Definition  

Melasma is a skin condition where brown patches appear on the skin. These patches usually appear on the cheeks, nose, forehead, chin, and upper lip. Patches can also appear on the neck and forearms.

Because it is common in pregnant women, melasma may be referred to as the mask of pregnancy.

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Causes  

The brown patches are due to an increased amount of melanin in the skin. The exact cause of increase in melanin is unknown. It is thought to be associated with hormones such as estrogen and progesterone. Sun exposure also plays a major role.

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Risk Factors  

Melasma is more common in women during their reproductive years, but it can occur in men. Other factors that increase may your chance of melasma include:

  • Family history of melasma
  • Being a woman of reproductive age
  • Having a darker skin tone
  • Pregnancy
  • Getting too much sun exposure
  • Taking birth control pills
  • Using products that irritate the skin, such as cosmetics
  • Certain medications, such as antiseizure drugs or hormone therapy
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Symptoms  

The only sign of melasma is dark patches of skin. It is not painful or itchy.

Not all brown patches on your skin are melasma. Talk to your doctor about changes in your skin.

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Diagnosis  

Your doctor will ask about your symptoms and medical history. Your skin will be examined. A lamp, called a Wood’s lamp, may be used to look at your skin. A small sample of skin may be taken for a biopsy. The sample will be sent to a lab to confirm the diagnosis.

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Treatment  

Melasma may go away on its own. If it does not go away, it may need to be treated. In general, treating melasma can be difficult. Talk with your doctor about the best treatment plan for you.

Removing Cause  

Factors that are causing the melasma may be removed. For example:

  • Melasma associated with pregnancy may slowly fade after giving birth
  • Melasma associated with birth control pills or hormone replacement therapy may fade after the medication is stopped

It can reappear and become darker if you become pregnant again or resume taking medication.

Avoid using products that can irritate your skin. These include make-up, creams, and cleansers.

Ultraviolet Light Protection  

Protecting your skin from UV light is important in helping to fade melasma. This means avoiding sun and tanning bed exposure. Your doctor may recommend wearing sunscreen, clothing, and hats when outdoors.

Depigmenting Medications  

Certain medications, like bleaching creams, are used to lighten skin color. A common bleaching cream used to treat melasma is hydroquinone. This may also be used with other creams or combination of creams such as tretinoin, corticosteroids, azelaic acid or glycolic acid. These creams enhance the skin-lightening effect.

Your skin may be sensitive to these medications. Use care and start slowly when first using them. It may take several months before you see an improvement.

Other Treatments  

Other treatments remove outer layers of the skin. These include:

  • Chemical peel
  • Microdermabrasion—removing top layer of skin
  • Laser therapy
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Prevention  

To help reduce your chance of getting melasma:

  • Limit the amount of time you spend in the sun. Avoid using tanning booths.
  • Use sunscreen daily. Wear sunscreen that protects against both UVA and UVB rays and has an SPF of 30 or more.