Hyperpigmentation, in general, is a frustrating skin care issue to deal with, and melasma on the face can be particularly tricky to treat. For one thing, experts don’t know exactly what causes the common condition. Plus, there are a few unique factors at play that separate it from other kinds of dark spots. That’s why, if you want it to fade, you’re going to need a specific and strategic plan.
Melasma can affect pretty much anyone, although it’s much more common in women than men.1 It also occurs in all skin tones, however, certain ethnic groups with higher pigmentation may be more susceptible—an important factor to consider if you’re caring for skin of color.2
There’s no cure for melasma but there’s better news if you have it and wish it would go away sooner rather than later: There are plenty of proven and effective ways to manage it. Here, dermatologists explain exactly what melasma on the face is, the causes behind it, and the best skin-brightening solutions for addressing it.
What is melasma? | Melasma causes | Melasma in darker skin tones | How to treat melasma on the face
What is melasma, exactly?
“Melasma is a pigmentary skin condition characterized by darkened patches that typically look brown or grayish,” Hayley Goldbach, MD, a board-certified dermatologist and assistant professor of dermatology at Brown University, tells SELF. “It most often appears on the face, particularly the cheeks, the forehead, and the upper lip.” (It can also crop up on parts of the body that are regularly exposed to the sun, such as the arms and neck, per the American Academy of Dermatology.)
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The major difference, appearance-wise, separating it from other types of hyperpigmentation? Its presentation. “Whereas sun spots are more discreet and individual, melasma comes together in patches of darker skin that look irregular and blotchy,” Marisa Garshick, MD, a dermatologist at MDCS Dermatology and clinical assistant professor at Cornell University, tells SELF. This could be one small patch or several smaller ones that blend together into one larger area of discoloration, Dr. Garshick adds.
Melasma is fairly common; research shows that it affects anywhere from 1.5% to 33% of the population.1 However, a whopping 90% of people who develop the condition are women, Nazanin Saedi, MD, a board-certified dermatologist in Philadelphia and a clinical associate professor at Thomas Jefferson University, tells SELF. “I’ve been practicing for 15 years and have only seen a handful of male melasma patients during that time,” she says. So, why the gender bias? It has to do with the root causes of the issue…
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What causes melasma to show up?
Here’s the big caveat: All of the dermatologists SELF spoke with underscored the fact that there’s still a lot that we don’t know about melasma and, specifically, what causes it. Still, it’s clear that hormones are key players. Experts agree that both estrogen and progesterone are involved—exactly how remains to be discovered, but the theory is that increased levels of these hormones cause a surge in melanin (pigment) production, Dr. Saedi explains. “This is why melasma is so common in pregnancy. It’s reported that anywhere from 15% to 50% of pregnant people will develop it, and it’s even called ‘the mask of pregnancy,’” she adds.1 (Similarly, folks on birth control pills may also get melasma.)3 But hormonal shifts are only one piece of the puzzle. Genetics are a factor, too: “Around half of all melasma patients report having a family history of it,” Dr. Goldbach points out.
There’s also the sun-exposure factor: Ultraviolet rays trigger the production of melanin as a protective mechanism.4 In short, that means that the sun plays a part in any and all types of hyperpigmentation. In the case of melasma, there’s an interplay with those aforementioned hormonal changes that have already revved up melanin production, says Dr. Goldbach. “It’s why melasma shows up on the most sun-exposed areas of the face and why it’s worse in the summer than in the winter,” adds Dr. Saedi.
