Hyperpigmentation can be a difficult skin issue to handle. Melasma is particularly hard to treat. For one thing, experts don’t know exactly what causes the common condition. It’s also different than other types of dark spots because it has a unique set of factors. That’s why, if you want it to fade, you’re going to need a specific and strategic plan.
Melasma can affect pretty much anyone, although it’s much more common in women than men.1 It also occurs in all skin tones, however, certain ethnic groups with higher pigmentation may be more susceptible—an important factor to consider if you’re caring for skin of color.2
There’s no cure for melasma but there’s better news if you have it and wish it would go away sooner rather than later: There are plenty of proven and effective ways to manage it. Dermatologists describe melasma, its causes and the best ways to treat it.
What is melasma and what causes it? | Melasma can be caused by a number of factors | Melasma in darker skin tones | How to treat Melasma On The Face
What exactly is melasma?
“Melasma is a pigmentary skin condition characterized by darkened patches that typically look brown or grayish,” Hayley Goldbach, MD, a board-certified dermatologist and assistant professor of dermatology at Brown University, tells SELF. “It most often appears on the face, particularly the cheeks, the forehead, and the upper lip.” (It can also crop up on parts of the body that are regularly exposed to the sun, such as the arms and neck, per the American Academy of Dermatology.)
What’s the most important difference between this type of hyperpigmentation and others? Its appearance. “Whereas sun spots are more discreet and individual, melasma comes together in patches of darker skin that look irregular and blotchy,” Marisa Garshick, MD, a dermatologist at MDCS Dermatology and clinical assistant professor at Cornell University, tells SELF. Dr. Garshick says that it could be a small patch, or several smaller patches that merge together to form a larger area of discoloration.
Melasma can affect anywhere between 1.5% and 33.3% of the population, according to studies.1 Nazanin Saedi MD, a boardcertified dermatologist from Philadelphia and clinical associate at Thomas Jefferson University tells SELF, “90% of those who develop this condition are female.” “I’ve been practicing for 15 years and have only seen a handful of male melasma patients during that time,” she says. Why is there a gender bias in the treatment of melasma? It has to do with the root causes of the issue….
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What can cause melasma?
Here’s the big caveat: All of the dermatologists SELF spoke with underscored the fact that there’s still a lot that we don’t know about melasma and, specifically, what causes it. Still, it’s clear that hormones are key players. Experts agree that both estrogen and progesterone are involved—exactly how remains to be discovered, but the theory is that increased levels of these hormones cause a surge in melanin (pigment) production, Dr. Saedi explains. “This is why melasma is so common in pregnancy. It’s reported that anywhere from 15 to 50% of pregnant people will develop it, and it’s even called ‘the mask of pregnancy,’” she adds.1 The same is true for people taking birth control pills.3 But hormonal changes are just one part of the puzzle. Genetics are a factor too: “Around half of all melasma patients report having a family history of it,” Dr. Goldbach points out.
There’s also the sun-exposure factor: Ultraviolet rays trigger the production of melanin as a protective mechanism.4 The sun can play a role in hyperpigmentation of all kinds. In the case of melasma, there’s an interplay with those aforementioned hormonal changes that have already revved up melanin production, says Dr. Goldbach. “It’s why melasma shows up on the most sun-exposed areas of the face and why it’s worse in the summer than in the winter,” adds Dr. Saedi.