Melasma

What is melasma?
Flat patches of brown pigmentation, most often on the face

What causes melasma?
Sun exposure, genetics, hormones

How can melasma be treated?
Sun protection
Ingredients including hydroquinone, azelaic acid, ascorbic acid, tretinoin, niacinamide, kojic acid, arbutin, cysteamine
Superficial chemical peels
Oral tranexamic acid
In select cases, lasers and intense pulsed light

Also known as ‘the mask of pregnancy’, melasma, also called chloasma, is a common and very troubling issue for some people.It’s important that it’s diagnosed correctly, as there are many forms of pigmentation which can affect the face, and treatment is different for each type. Once you’re certain you have melasma, there are quite a few options to help fade it, with the most important being strict sun protection. 

What is melasma?

Melasma presents as flat patches of brown pigmentation, usually on the face. It’s more common in females and those with skin of colour, but can occur in anyone. 

What causes melasma?

Factors that contribute to the development of melasma include hormonal influences (including pregnancy and the use of hormonal contraceptives), sun exposure, and a family history. 

How can I fade my melasma?

The most important factor in improving the appearance of melasma is strict sun protection, particularly with sunscreens containing iron oxide, which helps protect against visible light. The use of sunscreen alone can improve melasma by up to 50%. Stopping contributing factors such as hormonal contraception may help, if appropriate, in consultation with a medical professional. Ingredients that can be helpful either alone or in combination include hydroquinone, niacinamide, azelaic acid, kojic acid, ascorbic acid, retinoids, arbutin and cysteamine.

Combination creams are available, most commonly on prescription, containing combinations of ingredients such as tretinoin, hydroquinone and a topical corticosteroid, or hydroquinone with ascorbic acid and kojic acid

Superficial chemical peels, such as glycolic acid peels, may be helpful. 

Oral tranexamic acid may be effective in cases resistant to creams. It should be used for a limited time period only, and always under medical supervision. 

Light based therapies such as lasers and intense pulsed light may be effective for select cases of melasma, but caution must be taken as they have the potential to worsen melasma or cause post-inflammatory hyperpigmentation.

References
Fatima S, Braunberger T, Mohammad TF, Kohli I, Hamzavi IH. The Role of Sunscreen in Melasma and Postinflammatory Hyperpigmentation. Indian J Dermatol. 2020;65(1):5-10. 

Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-782. 

McKesey J, Tovar-Garza A, Pandya AG. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol. 2020 Apr;21(2):173-225. 

Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb). 2017;7(3):305-318.

SEARCH CONDITIONS A-Z

ABOUT THE AUTHOR

Dr-Julia-Rhodes

Spotlight on Skin was created by award-winning Melbourne-based dermatologist, Dr Julia Rhodes.

Julia knows first-hand how overwhelming the skincare world can be, and that’s with over 10 years of experience practicing dermatology. Given that even she gets overwhelmed, she appreciates how hard it can be for those of you without a scientific background to make sense of all the information available, and choose products that are right for your skin…