5th July, 202211 min read

Melasma: what it is and how to treat it

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Have you noticed darker patches of skin appearing on your face, or other parts of your body that are out in the sunlight?

If so, you might be feeling self-conscious, or worried that it could be a sign of something serious. But it’s likely to be a skin condition called melasma, also known as chloasma. It happens when your skin makes extra pigment, and is thought to be triggered by a mix of things, including your genes, hormones, sun exposure and stress.

Melasma isn’t serious or catching (infectious), and it doesn't lead to skin cancer. But we know that changes to how your skin looks can affect your confidence. You may feel frustrated, or confused about why it’s happening. Which is why we’re here to explain what causes it and how you can manage it – to help you feel comfortable in your skin.

What are the signs of melasma?

Melasma is a skin condition where some areas of your skin become darker – or more ‘pigmented’ – than the rest.

These darker areas:

  • can be various shades of brown or have a blue/grey tint, depending on your skin colour
  • often appear on your face – such as on your cheeks, temples or forehead
  • can also affect other areas that are exposed to the sun, such as your neck and forearms
  • usually become more noticeable in the summer and fade in the winter

While it isn’t painful or itchy, melasma can be quite noticeable, which can have an impact on your wellbeing. But rest assured that there is help available.

Who is most likely to get it?

Melasma often first appears when you’re aged between 20 and 40. It’s more common if:

  • you’re a woman – according to BMJ Best Practice, 9 out of 10 people with melasma are women
  • you have a darker skin type – including if you’re of Black, Asian, Hispanic or Native American heritage
  • you’re
    pregnant
    – research suggests up to 50% of women get melasma during pregnancy, which is why it’s sometimes called the ‘pregnancy mask’

What causes melasma?

We don’t fully understand what causes melasma. But it happens when skin cells called melanocytes make too much skin pigment – called melanin – in certain parts of your skin. This causes darker patches of skin in these areas.

Although it isn’t always clear why they can trigger it, several things can increase your risk of melasma, including:

  • your genes – research suggests at least 1 in 3 people with melasma know family members who also have it
  • frequent sun exposure – the ultraviolet (UV) rays in sunshine can cause your skin cells to make more pigment. So things such as living in a sunny climate, spending lots of time in the sun or using
    sunbeds
    can trigger melasma or make it worse
  • pregnancy – melasma can happen alongside other common skin changes in pregnancy, such as darkening of your nipples and a dark line on your tummy (linea nigra). It’s thought that changing hormone levels play a part in this. It may go away a few months after you’ve had your baby, although it can come back if you get pregnant again
  • hormonal medication – such as if you’re using a type of contraception that contains oestrogen and/or progesterone, or you’re having hormone replacement therapy (HRT) for menopause symptoms
  • epilepsy
    medication
  • some beauty products – especially those containing perfume
  • stress

Is it melasma or something else?

‘Hyperpigmentation’ is any condition where a certain area of your skin becomes darker than the skin that surrounds it. As well as melasma, it includes things such as freckles, age spots (liver spots) and acne scarring.

If you’re concerned about any changes in your skin colour, discuss it with your doctor, so they can check what’s causing it. You can also try our Smart Symptom Checker to help you work out your best next steps.

Self-care for melasma

Avoiding triggers

First, try to work out if your melasma is being triggered by something you could avoid. For example:

  • if you’re taking hormonal contraception or HRT, it might be a good idea to discuss possible alternatives with your doctor
  • switch to using gentle, fragrance-free skincare products. Avoid perfumed products, and stop using anything that burns or stings when you apply it – this means it’s irritating your skin
  • try to keep your stress levels as low as possible – read about
    stress relief

Sun protection

Sun exposure can make your darkened patches worse, so it’s very important to protect your skin.

You can do this by following some sun safety tips, including:

  • using
    sunscreen
    every day (even if it’s cloudy). This needs to protect against both UVA and UVB rays, so choose a product with a sun protection factor (SPF) of at least 30, and a UVA rating of 4 or 5 stars
  • wearing sunglasses and a broad-brimmed hat when you’re in the sun, to protect your eye area, face and neck
  • staying out of the sun between 11am and 3pm, when UV rays are strongest
  • avoiding using sunbeds

Read more about

staying safe in the sun
, and
sunscreen and how to apply it
.

Make-up

If you don’t like how your melasma looks and feel self-conscious about it, you can use camouflage make-up to cover it up. This includes special creams and powders, which are matched to your skin tone and don’t come off easily.

In the UK, the

Changing Faces Skin Camouflage Service
can help you find the right products for you, and teach you how to apply them. You can also watch their
videos
for tips.

When to see a doctor

It’s best to see your doctor if you’ve noticed any changes to the colour of your skin. They’ll be able to check if it’s melasma, and recommend treatment if you need it.

Your doctor can also help if you have melasma that’s bothering you and you don’t feel that self-care measures are helping, or if it’s causing

anxiety
or other
mental health issues
.

How is melasma diagnosed?

Your doctor will usually be able to diagnose melasma from looking at your skin, without doing any tests or investigations. In some cases, you may be referred to a skin specialist called a dermatologist.

If they think your symptoms could be caused by another skin condition, they may arrange for you to have a skin

biopsy
– where a small sample of your skin (numbed by
local anaesthetic
) is taken and examined under a microscope. Occasionally,
blood tests
might also be needed.

Signs you need to see your doctor as soon as possible

There are also a few rare, but more serious, conditions that can cause darkening of the skin, including

Addison’s disease
and
haemochromatosis
.

See a doctor as soon as possible if you also:

  • notice the skin darkening in the creases of your palms, gums, nipples, armpits or belly button, or darkening of your hair or nails
  • feel very tired all the time
  • lose weight without meaning to
  • feel dizzy when you stand up
  • have tummy pain or vomiting
  • feel low or depressed
  • have yellowing of your skin or eyes
  • get swollen ankles or feel short of breath

Doctor’s tip

“It’s normal to feel anxious or self-conscious about how your skin looks, and we know that having melasma can affect your mental health,” says Dr Roger Henderson. “So don’t think that it’s something you have to put up with – getting help can be important for looking after your wellbeing. But like lots of skin conditions, melasma isn’t always easy to treat, and it can take time. So do talk to your doctor if you feel your mental health is being affected – they can refer you for treatment such as counselling, if appropriate.”

Melasma treatments

As well as self-care measures such as sun protection, your doctor or a skin specialist may prescribe or recommend 1 or more of these treatments.

Skin-lightening creams

  • these are creams you apply to help to lighten dark patches of skin
  • they should only be used if they are prescribed, to help reduce the risk of side effects (such as skin redness and swelling, stinging, itching or flaking)
  • they usually contain the medicine hydroquinone, and sometimes a
    steroid
    such as hydrocortisone and a retinoid such as tretinoin
  • creams that contain all 3 of these medicines have been shown to be most effective
  • hydroquinone creams may cause skin irritation. You should only use them for a few weeks at a time, to avoid over-lightening your skin. They’re not suitable for use during pregnancy
  • steroid creams
    can help prevent skin irritation, but shouldn’t be used on your face for more than 12 weeks, because they can cause skin thinning and
    acne
  • retinoid creams such as tretinoin can be prescribed for melasma on their own, too, though they can also cause skin irritation
  • azelaic acid cream can be prescribed in some cases, although it often causes irritation. If it’s still causing irritation after 4 weeks, it should be stopped, because it may actually make melasma worse
  • non-prescription skin-lightening creams containing hydroquinone, steroids or mercury are banned in the UK, because they can cause serious side effects if they’re not used correctly

Tranexamic acid

  • this can be prescribed as a tablet you swallow
  • it’s been shown to help some people when it’s taken for 12 weeks
  • you shouldn’t take it if you have an increased risk of blood clots (such as if you have a history of
    deep vein thrombosis
    ,
    pulmonary embolism
    or multiple
    miscarriage
    )

Chemical peels

  • this is a procedure that removes the outer layer of your skin, which contains the excess pigment
  • it may be recommended if skin-lightening creams don’t help
  • it should only be done by a trained skin specialist – it may make your pigmentation worse if it’s not done correctly
  • your doctor may be able to advise about local practitioners

Laser skin lightening

  • this treatment uses a laser light to improve dark patches by either removing the outer layer of your skin or damaging the skin cells that produce pigment
  • it doesn’t work for everyone, and you may need several sessions to see any results
  • it should only be done by an experienced laser specialist – your doctor may be able to advise about where it’s available
  • it can cause temporary skin darkening, but this usually goes away on its own or can be treated with hydroquinone cream
  • other possible side effects include bruising, swelling and blistering, but these will go away after 1 to 2 weeks

Microneedling

  • this involves using a device with very fine needles to make tiny (microscopic) tears in your skin
  • it triggers your skin’s healing response, and your skin tone should look more even as it heals
  • like the treatments above, it should only be done by a qualified and experienced skin specialist – your doctor may be able to advise

Remember that whatever treatment you have, your melasma is likely to come back if you don’t use sun protection – so don’t forget that sunscreen!

Your health questions answered

Can melasma be cured?

Answered by:

Dr Roger Henderson

“Melasma is typically a ‘chronic’ condition, which means it lasts for 3 months or more. And unfortunately, there’s no 1 treatment that will automatically make it disappear. In many cases (although not always), it fades away by itself – particularly after the end of pregnancy, or if you stop taking the contraceptive pill. But this varies from person to person – it may go away on its own or respond well to treatment, or it may be permanent. Avoiding strong sunlight is vital to help prevent it coming back or getting worse.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.