Daniel Popkin, M.D.
Melasma is a skin condition in which dark patches appear on the face (forehead, cheeks, and upper lip). It is due to excessive pigment (melanin) collecting in the skin. The dark patches usually have distinct edges and are symmetrical (similar on both sides of the face). When it occurs during pregnancy, it is often referred to as "chloasma" or the "mask of pregnancy."
Melasma is very common and occurs in up to six million American women. Although people with melasma may be concerned about its appearance, it is a harmless condition that causes no other health problems.
Melasma can be categorized as "epidermal" or "dermal", or mixed.
Epidermal melasma means the pigment (melanin) is in the more superficial layers of the skin called the epidermis.
Dermal melasma means that the pigment is in the deeper layers of the skin. This distinction is important because epidermal melasma responds more quickly to treatment.
Your doctor may use a "Wood's Lamp" to determine what type of melasma you have.
Although melasma can occur in men, it is most common in women, especially in women of Hispanic or Asian ancestry. If your relatives had melasma, you are also at greater risk of developing melasma.
Women are also at greater risk of developing melasma if they are pregnant, take birth control pills, or take hormone replacement therapy.
Sunlight is essential to the development of melasma. People at risk of developing melasma will notice the patches becoming darker following exposure to sunlight.
Treatment results vary greatly among individuals. Your recommended treatment will depend largely on your type of melasma, dermal or epidermal.
Some people with epidermal melasma experience rapid improvement within four to eight weeks of starting treatment, while others may find that improvement takes many months.
It may take time to respond to treatment, so be patient.
Medications for Melasma
The medications prescribed for melasma are called "bleaching" or "depigmenting" agents that cause the skin to stop making melanin.
Procedures for Melasma
Your doctor may discuss the option of various dermatologic procedures that may reduce the appearance of the dark patches, including chemical peels, dermabrasion, or lasers. Fractional lasers have been found to be particularly effective for some types of melasma.
Cosmetic Cover Ups
While waiting for the discoloration to fade, consider using cover-up to reduce the appearance of melasma.
Avoiding exposure to sunlight is the most important step in treating melasma and preventing its return. Sunlight is a powerful trigger of pigment formation in people susceptible to melasma. It is strong enough to counteract the effects of medications, even through car windows or on cloudy days.
If you will be exposed to sunlight, take the following measures to prevent the sun from contacting your face:
When selecting a sunscreen, consider the following:
Last updated May 8, 2011.
Images courtesy of Gerald Goldberg, M.D.