Melasma

Melasma is the gradual darkening of the skin in certain characteristic areas, typically the forehead and upper lateral cheeks. It can also occur in a variety of other areas, such as the upper lip.

Who gets melasma ?

Women and skin of color patients are at higher risk of melasma. Is it sometimes referred to as the mask of pregnancy, because hormonal changes such as pregnancy can be a contributing factor. Another contributing factor is the use of hormonal contraception.

How do I know if I have Melasma ?

It presents as well demarcated patches of darker skin, usually on the temples and upper cheeks, and sometimes on the forehead and lip region. It does not have any texture, such as scaling, and is without symptoms.

How can I treat Melasma ?

The most important aspect of treating melasma is sun protection. Therefore, it is important to use sunscreen every day on days when leaving the house and to reapply it when planning to be in the sun for a prolonged period of time. Wide brimmed hats can also be helpful. Additionally there is an oral sunscreen that may be used in conjunction with the above for additional sun protection, Heliocare (can purchase from Amazon). Other treatments for melasma include bleaching creams, containing hydroquinone, as well as creams containing ingredients that help lighten the darker portions of the skin such as tretinoin, azelaic acid, and kojic acid. Glycolic peels may also be helpful. The use of sun protection and lightening creams remains the first line gold standard for treatment. Various lasers have been tried for refractory melasma, but potential side effects (e.g. post inflammatory hyperpigmentation) and modest results have limited their use.

How can I prevent Melasma ?

The use of daily and regular sun protection is important for preventing melasma recurrence. Also, there are some creams such as retinoids that may be used long term for maintenance, as long as one is not pregnant or breast feeding.

When should I see a dermatologist about it ?

You can see a dermatologist for your melasma at any time, to confirm the diagnosis, treat it early and get tips on avoiding worsening or recurrence.

Additional Resources:
American Society for Dermatologic Surgery
American Society for Laser Medicine and Surgery
American Academy of Dermatology