It’s time to lighten up about melasma, a common skin disorder which literally means black spot. People with melasma experience light brown, dark brown and/or blue-gray patches on their skin, in the form of flat patches or freckle-like spots. The most affected areas include the face, particularly the cheeks, upper lip and forehead, as well as the forearms.
Often thrown under the umbrella term of hyperpigmentation, melasma is akin to post-inflammatory hyperpigmentation (PIH) and sunspots, which share the common trait of patches of skin becoming darker than the surrounding area. Sometimes called the “mask of pregnancy” melasma frequently affects pregnant women. Melasma can be cyclical, darkening and lightening over time—it gets worse in the summer and better in the winter.
What causes melasma?
While more research is needed, melasma occurs when the color-making cells in the skin (melanocytes) produce too much color. People with skin of color are more susceptible to melasma because they have more active melanocytes than people with lighter skin. The most common culprit to trigger melasma is sun exposure, as the ultraviolet (UV) light from the sun stimulates the melanocytes. Even just a small amount of sun exposure can make melasma return after fading, which is why melasma tends to worsen in summer.
Not as common, but still a factor in the condition, is artificial light from your lightbulbs, computer screen and cellphone. While blue light impacts melasma, it’s much milder than light from the sun.
Parenting, alas, can be bad for your face. The change of hormones that occurs during pregnancy can trigger melasma. Birth control pills and hormone replacement medicine can also set off melasma.
How common is melasma?
Among pregnant women, melasma is a very common skin disorder, with between 15 percent to 50 percent of pregnant showing symptoms. According to the Cleveland Clinic, “between 1.5 percent and 33 percent of the population may get melasma and it happens more often during a woman’s reproductive years, and rarely happens during puberty. It usually starts between 20 and 40 years of age.”
Who is at risk of melasma?
As noted earlier, fairer-skinned people are less likely to be affected by melasma than those with darker brown skin or those predisposed to tan well. Women are more likely to get melasma than men—men are one tenth as likely to affected. Pregnant women get melasma more often than anyone else.
Can melasma be prevented?
Unfortunately, there is no definitive treatment that will make melasma disappear for good. But there are several precautions you can take to prevent it from intensifying. In terms of proactive approaches, it’s all about avoiding the sun. Being vigilant about sun exposure is the best thing you can do for your face. If you will be exposed to the sun, be sure to wear sunscreen with iron oxides (not chemical sunscreens) and a SPF of 30-50 applied every two hours, as well as a wide-brimmed hat. Avoid tanning beds and limiting exposure to LED screens is also of paramount importance.
Pro tip: Many dermatologists suggest layering a topical vitamin C serum under sunscreen every morning. Think of vitamin C as your go-to ingredient if you have hyperpigmentation. A true multi-tasker, it protects the skin from UV light and free-radical damage, while blocking production of abnormal pigmentation.
What is the best treatment for melasma?
Melasma is difficult to treat because any inflammation can worsen melasma and many of the treatments inadvertently can cause irritation. In general, topical treatments for melasma are aimed at slowing or halting pigment production by melanocytes. The goal is to fade existing pigment in the skin.
There are a bevy of topical medications for this. One of the most ubiquitous “faders” is hydroquinone, an effective, albeit controversial, bleaching agent. Dermatologists consider hydroquinone the gold standard for melasma treatment. It’s available in over-the-counter skin-care products at 2 percent, however, dermatologists often prescribe it at higher strengths for melasma. So why is it controversial? Studies have shown that it is potentially carcinogenic when ingested by rats.
Hydroquinone has been banned in Europe in concentrations higher than 1 percent. As of September 2020, hydroquinone products were banned in the US, although there are several loopholes that still permit sales. Most dermatologists consider overuse to be the biggest concern regarding hydroquinone.
In terms of in-office treatment options for melasma, topical peels using alpha-hydroxy acids (often glycolic, lactic and trichloracetic), as well as microdermabrasion and microneedling are some of the more popular options. All these treatments remove the top layer of skin, which may help melasma by allowing other ingredients to penetrate the skin surface. Laser therapy, which is purported to break up pigment, is another in-office treatment that must be performed carefully to avoid aggravating melasma.
If you’re experiencing melasma, consult with a board-certified dermatologist who can put together a prescription-based, customized plan that’s right for you. That, and using sunscreen every single day, even if you don’t leave the house.