Melasma is a common skin problem, most often seen in women of color. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin and above their upper lip. It also can appear on other sun-exposed parts of the body, such as the forearms and neck.
Common melasma triggers include:
- Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. In fact, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma is typically worse in summer. It is also the main reason people with melasma have frequent recurrences.
- A change in hormones: Pregnant women often get melasma. When melasma appears in the pregnant patient, it is called chloasma, or the mask of pregnancy. Birth control pills and hormone replacement medicine may also trigger melasma.
- Cosmetics: Skin care products that irritate the skin may worsen melasma.
The most important treatment for melasma is a daily sunscreen that protects against UVA and UVB with an SPF of 30 or higher. Affected patients should consider alternates to hormonal contraception and irritating skin products should be discontinued. The most popular treatment is with a topical bleaching cream that contains hydroquinone or with compound products that also include a mild corticosteroid and a retinoid. In some patients, chemical peels and laser therapies may be recommended to accelerate improvement. It is important to remember that even minimal exposure to ultraviolet light can cause melasma to recur.