Melasma is a skin condition where dark patches appear most commonly on the face. More research is
needed to find the exact cause, although there are some well-known triggers. While melasma is usually
asymptomatic, the contrast of the hyperpigmentation compared to non-involved skin on such a visible
area like the face can make it an understandably worrisome skin issue that many desire treatment for.
Melasma is more common in women (typically between the ages of 20-40 years old) and in darker skin
tones. There may be a genetic component to melasma, although the exact gene is unknown.
Common triggers include:
• Sunlight/ UV light- However, there are some studies showing that even visible light can be a trigger
• High estrogen states- pregnancy (why melasma is sometimes called the “mask of pregancy), oral contraceptive pills, hormone replacement therapy
• Medications- anti-seizure medications, ones that increase sun sensitivity (some antibiotics and blood pressure medications)
• Thyroid disease
Melasma can last for years or resolve quickly once the inciting trigger has been eliminated.
There are topical regimens containing hydroquinone (a traditional “bleaching” cream but cannot be used long-term as it can cause darkening itself with prolonged use), dicarboxylic acids such as azelaic acid and kojic acid, mild corticosteroids, and tretinoin.
Procedural treatments include microneedling, chemical peels, and lasers; however, caution must be taken with the last two options as they can lead to post-inflammatory hyperpigmentation if they are too strong and “burn” or damage the skin.
A key management strategy is avoiding triggers, so minimizing sun exposure, wearing mineral-based sunscreen (blocks all types of light, including UV and visible light), and management of any medications or thyroid issues with the appropriate medical provider.
