Melasma

What is melasma?

Melasma is a common cause of brown or grey-brown patches of pigment, mostly on the face. It is harmless and does not affect general health, but it can be persistent and can have a significant effect on confidence.

Who gets it?

Women make up over 9 in 10 people with melasma, and it generally begins in the 20s or 30s. It is particularly common during pregnancy, when up to half of women may develop it. It is most common in people with light brown to medium brown skin and in those who tan easily, although it can affect anyone. Men can also develop it.

What causes it?

In melasma, the skin's pigment cells make more melanin than they should. Several factors contribute.

Ultraviolet light from the sun or sunbeds is the most important trigger, and melasma typically darkens in the summer. Visible light, including from screens and indoor lighting, and heat may also play a part.

Hormones are closely linked. Melasma often appears during pregnancy, when it is sometimes called the mask of pregnancy, and with the combined contraceptive pill or hormone replacement therapy.

Thyroid problems and some anti-epileptic medicines are also associated with it.

Some cosmetics, scented products and irritating skincare can make it worse.

Is it hereditary or contagious?

Melasma often runs in families, and more than half of people with it have an affected relative, but it is not passed on in a predictable way. It cannot be caught from others and is not an allergic reaction.

What does it look and feel like?

Melasma causes flat, symmetrical patches of light to dark brown or grey-brown pigmentation, with irregular edges. The most common areas are the cheeks, forehead, bridge of the nose, upper lip and chin. Less often it affects the jawline, neck or forearms. It does not cause itch or pain.

The pigment can sit in the upper layer of the skin, the deeper layer, or both. Deeper pigment tends to look more grey or bluish and is usually more persistent.

How is it diagnosed?

Melasma is diagnosed from its appearance and pattern. A Wood's lamp or dermoscopy may be used to assess how deep the pigment sits. Other causes of facial pigmentation, such as post-inflammatory hyperpigmentation, sun damage, reactions to medicines or fragrances, and rarer conditions, are considered as part of the assessment. Occasionally a skin biopsy is taken to rule out other conditions.

What are the treatment options?

Dr Mounsey will confirm the diagnosis and look for contributing factors such as hormonal treatment. Strict daily sun protection with a broad-spectrum tinted sunscreen is essential, as visible light also worsens melasma. Treatment options include creams such as hydroquinone, often in a combination formula with a retinoid and a mild steroid, azelaic acid, and other lightening agents. Tranexamic acid tablets may help some people. Chemical peels or lasers may be considered with caution, and Dr Mounsey can advise on these. Melasma can return, so a maintenance plan is usually needed.

What is the outlook?

Melasma linked to pregnancy may fade gradually after delivery. In most people, however, melasma is a long-term condition that tends to come and go, and it often darkens again with sun exposure. There is no cure, but good long-term control is achievable with ongoing care and careful sun protection.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/melasma

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.