Everything You Need to Know About Melasma

woman with melasma on her face forehead upper lip and chin

Pregnancy mask, discoloration, brown patches, mustache—whatever you call it, melasma is a common skin condition that affects around six million women in the United States. Even though melasma is common, it can be tricky to identify and even trickier to treat. Keep reading to learn more about how to tell the difference between melasma and other types of pigmentation as well as the best treatments for melasma.

What is Melasma and What Causes It?

Melasma is a pigmentation disorder characterized by brown or grey-brown patches on the skin. You can develop melasma anywhere, but it most commonly appears on the forehead, around the mouth (especially upper lip), or along the outer perimeters of the face and cheeks.

Essentially, melasma is an overproduction of melanin. Melanocytes are cells that live in the dermis (the deepest layer of the skin) and produce melanin (pigment). Melanin is bundled up in melanosomes, which move up to the surface of the skin and disperse. This then shows up as color on the skin.

No one is quite sure what actually causes melasma, but there are a few well-known triggers. Hormones are the most common trigger, but other possibilities include UV exposure and skin irritation. Melasma doesn’t pose any medical risk, but once the melanin factory turns on, it can be hard to calm fussy pigment cells back down.

Who Can Get It?

While anyone can technically get melasma, some are more prone to it than others.

  • Women. Women’s hormones stay quite active throughout adulthood whereas men’s hormones tend to calm down after adolescence. Since hormonal fluctuations are a common trigger for melasma, women are far more prone to it than men. In fact, 90 percent of melasma cases occur in women.
  • Those who are pregnant. Few hormonal fluctuations are as intense as pregnancy! In fact, melasma is often referred to as the “mask of pregnancy” because so many women start to experience it during this time.
  • Those on hormonal birth control. Since many hormonal birth control methods essentially mimic a state of pregnancy in the body, prolonged use can definitely trigger melasma. Learn more about how birth control affects the skin.
  • Those with deeper skin tones. As I mentioned, melasma stems from an overproduction of melanin. Those with deeper skin tones have more active melanocytes than those with lighter skin, so it’s easier for them to be over-stimulated.
  • Those genetically predisposed. If one of your immediate relatives has melasma, you’re more likely to develop it at some point.

How Can I Tell the Difference Between Melasma and Hyperpigmentation?

Melasma is one of four types of hyperpigmentation (an overproduction of pigment in the skin):

  1. Melasma. Large dark brown or greyish patches that usually show up on the forehead, cheeks, or around the mouth.
  2. Post-inflammatory hyperpigmentation (PIH). Smaller, individual dark spots leftover from trauma to the skin. This could be a blemish, bug bite, cute, or scratch. To fade PIH, I love my Post-Breakout Fading Gel.
  3. Age/Sun Spots. Flat spots ranging from light to dark brown in color. These are mainly caused by sun exposure over time.
  4. Freckles. Small brown spots brought on during childhood—a genetic condition.

At-Home Test

So how can you tell whether you’re dealing with melasma or one of the other three types of hyperpigmentation? If you suspect you have melasma, it’s ideal to have it confirmed by a trained dermatologist who can help you differentiate. In the meantime, though, there is a simple test you can do at home to identify the depth of the problem:

  • In a well-lit room, after cleansing your hands and face, gently stretch the area of the face that appears discolored.
  • If the skin appears lighter when stretched than when at rest, the pigmentation is close to the surface and mostly superficial. This means it’s likely not melasma, rather one of the other three types of hyperpigmentation.
  • If the skin appears darker when stretched than when at rest, the pigmentation lies in the deepest layers of the skin and will be more challenging to treat. If it is truly melasma, it will more than likely be in the deeper layers.

What Are the Best Ways to Get Rid of Melasma?

While you can get rid of melasma in some cases, it’s not always possible. Melasma is very complex and occurs so deeply within the skin that it can be really difficult to treat. The success of the treatment is based on an individual’s skin type and tolerance, and probably most importantly how dedicated they are to improving it and sticking to a regimen. What’s important to know is that even if you do get rid of melasma completely, there’s a good chance you’ll have to continue treatments as it can easily creep back up if you’re not staying on top of it.

Lifestyle Changes

There are definitely things you can do at home and with a dermatologist to treat melasma, but first, it’s important to know that some lifestyle changes must be made in order for these treatments to have a successful outcome.

Avoid Sun Exposure

Hands down, staying out of the sun is the most important thing for keeping pigment cells calm. Wear sunscreen applied generously and often. Hats, protective clothing and staying in the shade are also your best defense.

Reduce Exposure to Heat

For years, it was thought that direct UV exposure was the only thing that increased pigmentation. We now know that heat also makes pigmentation worse by increasing the activity of melanocytes. This could be from a hot stove, saunas, steam rooms, exercise (particularly hot yoga), and even from niqabs which are traditional Muslim face coverings. These all increase the skin’s internal temperature. Try to avoid these as much as possible if you’re serious about reducing melasma.

Reconsider Your Birth Control

If your melasma appeared after going on hormonal birth control, you can discuss an alternative with your doctor.

At-Home Products

Depending on the severity of your melasma, you may be able to get it under control using only at-home treatments. Either way, being diligent about your daily routine is a crucial step in getting melasma under control.

Topical Pigment Inhibitors

Look for products with ingredients that will block tyrosinase. This will help interrupt signals being sent to melanocytes. These ingredients include hydroquinone, azelaic acid, kojic acid, arbutin, licorice extract, and vitamin C.

Note: If you opt for using hydroquinone, I recommend using at least a 4 percent strength formula, which is usually available in a prescription cream. Hydroquinone is particularly effective when combined with tretinoin (vitamin A) and a steroid (as found in Tri-Luma). Be careful to introduce such prescriptions slowly as they can cause irritation and dryness. You’ll need to make sure you’re doing everything you can to keep your skin’s barrier intact. Discuss with your doctor how long it should be used. If used too long, patients can develop ochronosis, a dark, blue-black pigmentation that is hard to get rid of.

Exfoliants

Exfoliation is important because it helps lift visible pigmentation off the skin. For acids, I like glycolic or salicylic. Fruit enzymes, such as papaya or pineapple, are also great options and are gentler than acids. Even though it isn’t technically an exfoliant, retinol is also great for pigmentation because it increases cell turnover. Pigmentation will come to the surface (where it can be sloughed off by exfoliants) more quickly. Pro Results Power Serum is my go-to recommendation for those with melasma. Finally, I do recommend a physical scrub for pigmentation. Read why here.

Makeup

As I’ve shared in this post, I think of makeup as a form of skincare in that it provides a barrier that protects your skin from UV light. In the case of melasma, it can also help conceal or color correct to make pigmentation less noticeable. It can be tricky to neutralize melasma pigment, so I suggest getting with a skilled makeup artist. They will help you determine the best makeup and techniques for your skin tone.

Cooling Products

As I said, heat is an enemy of melasma. If you are exposed to a lot of heat, try something simple like ice cubes or frozen peas to quickly cool your skin. You can also try keeping products like toner or masques in the fridge for an extra cooling effect. After being in the sun or heat, try a chilled, gel-based masque like Bio Calm Repair Masque for instant relief. You can also apply ice or a cool compress to the back of your neck while outside to prevent your internal temperature from rising too much.

Professional Treatments

How often you get professional treatments will vary from person to person. It’s important to get a consultation with an experienced provider who can tailor your treatment plan. There is no black and white answer as to how long it takes to get rid of melasma, but if you’re diligently treating it at home and with professional treatments, you can probably expect noticeable improvements within three months.

Chemical Peels

A series of chemical peels (salicylic, lactic or glycolic) can work to break up pigment cells that have risen to the surface. For a stronger treatment, you can inquire about getting a Jessner Peel, which includes salicylic and lactic acids as well as a resorcinol solution to provide deeper exfoliation.

No-Heat Laser

Many people have excellent success in removing unwanted pigment with laser treatments since they can penetrate into the deeper layers of the skin where melasma is formed. You’ll want to consult with a skin professional about which one is best suited for your skin.

Note: Winter is actually the best time of year to have these professional treatments done, especially for melasma. Since winter means less heat and sun exposure, you’re less likely to be exposed to factors that trigger melasma. This means the results of your treatment will last longer.

Bottom Line

Melasma is an incredibly complex and challenging condition that requires constant care. It can’t always be gotten rid of, but there are many things you can do both at home and with a dermatologist to keep it in check. Remember, patience is key. The pigment was forming in the skin long before it made its way to the surface, so it’s not just going to disappear overnight. But stay dedicated to your routine, and you’ll see results!

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