Dermatologists and Skin Care

Melasma (Dark Patches on Face): How to Get Rid of Them

Written by
Dr. Suvash Sahu
and medically reviewed by iCliniq medical review team.

Published on Dec 29, 2017 and last reviewed on Aug 12, 2019   -  2 min read

Abstract

Abstract

Melasma is one of the most common hyperpigmentation disorder that results in dark patches on the sun-exposed areas. Read the article to know more.

Melasma (Dark Patches on Face): How to Get Rid of Them

Causes

Melasma is an acquired hyperpigmentation where there is a formation of dark brown patches and spots on the skin of the face and sun-exposed areas. When it is induced by pregnancy, it is called chloasma. It is more common in women, especially, those in their reproductive years, but about 10 % of the cases occur in men as well.

Clinical Features

It is seen as irregular macular (flat, not raised) lesions of brown, blue-grey or brown-grey color that may occur in three patterns:

1. Centrofacial: involving the forehead, cheeks, upper lip, nose, and chin.

2. Malar pattern: involving the cheeks, and nose.

3. Mandibular pattern: involving the jaw.

Course of Melasma

Melasma usually runs a chronic course exacerbated by sunlight and artificial UVA and UVB light. Women have reported varying degrees of melasma during several pregnancies. Usually, melasma slowly resolves following childbirth or upon discontinuation of oral contraceptives.

Types of Melasma

Based on Wood’s lamp examination of skin, melasma can be divided into:

  • Epidermal: in this type melanin (pigment which synthesizes melanocytes responsible for the pigmentation of skin) deposition mainly occurs in the basal or suprabasal layer of the epidermis.
  • Dermal: melanin-laden macrophages are found in the superficial and mid dermis.
  • Mixed: melanin is found in both epidermis and dermis.

Treatment

  • The individual should try to avoid sun exposure as much as possible and follow certain sun-protection measures like avoiding the midday sun (especially between 10 AM to 4 PM), seeking shade whenever possible, and wearing a broad-brimmed hat whenever out in the sun.
  • Treatment of melasma during pregnancy or breastfeeding is not advisable.
  • Sunscreen, usually broad spectrum with an SPF of more than 30, noncomedogenic, oil-free base should be preferred and should be applied 30 minutes before going out in the sun and repeated every fourth-hourly to obtain its full efficacy.
  • Topical Hydroquinone cream 2 % should be used during night hours. This is suitable for superficial or epidermal melasma.
  • A combination of Hydroquinone cream 2 % and Tretinoin/ Isotretinoin 0.025 % and Hydrocortisone cream 0.05 % (Kligman’s regime) is better for deeper or dermal melasma.
  • Topical Azelaic acid, either alone or in combination with Isotretinoin can be used.
  • Chemical peeling 35 to 70 % Glycolic acid (GA peel) or 10 to 15 % Trichloroacetic acid peel (TCA peel) can be used.
  • Lasers like fractional CO2 and Q switched Nd YAG laser is, in recent times, the treatment of choice for resistant melasma.

For more information consult a melasma specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/melasma

Frequently Asked Questions


1.

What is melasma?

Melasma, otherwise called chloasma or mask of pregnancy, is a condition that results in dark black or brown patches on the skin.

2.

Can melasma be cured?

If the cause is hormonal imbalance during pregnancy or while taking birth control pills, it will fade on its own after delivery or after you stop taking the pills. Other treatment options include using topical Hydroquinone, Tretinoin, Corticosteroid, Kojic acid gel or cream. You can also try procedures like microdermabrasion, chemical peel, light therapy, and laser.

3.

How do you stop melasma from spreading?

The best way to prevent the spread of melasma is to avoid any triggers. Some of the common triggers include sun exposure, hormonal imbalance during pregnancy and people taking birth control or hormonal pills, and using skincare products that irritate the skin.

4.

What is the best way to treat melasma?

The best way to treat melasma is by treating the cause. Whenever you go out in the sun, wear protective clothing and apply sunscreen, avoid using harsh skincare products, and get the hormonal problem treated.

5.

Can melasma be cured permanently?

Unfortunately, there is no permanent cure for melasma as of now. All treatment options like cream and therapies only help reduce pigmentation to an extent. The best way to prevent melasma is by avoiding any triggers.

6.

What deficiency causes melasma?

Skin pigmentation is commonly associated with vitamin B12 deficiency.

7.

Does stress cause melasma?

Yes, stress can trigger and make melasma worse. Excess stress results in overproduction of melanocyte-stimulating hormone (MSH), which cause hyperpigmentation on the skin.

8.

How early in pregnancy can you get melasma?

Women can get melasma at any time during pregnancy. It can start as early as the first trimester and can continue throughout the pregnancy. It starts to fade after delivery or childbirth.

9.

What hormone imbalance causes melasma?

An imbalance in the hormone progesterone and estrogen causes melasma. This is the reason this skin condition affects pregnant women and women taking hormonal pills.

10.

What is the difference between chloasma and melasma?

Melasma that affects pregnant women is called chloasma or “mask of pregnancy.”

11.

Does melasma go away on its own?

Melasma fades away on its own after delivery or breastfeeding and after a woman stops taking birth control pills.

Last reviewed at:
12 Aug 2019  -  2 min read

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