Mastering Melasma

melasma treatment, dermatologist tips, sun spot prevention

Spots on the face are most likely to be caused by a skin condition known as melasma. Melasma is a common, patchy brown, tan or blue-gray skin discoloration due to overproduction of pigment on the skin.  Typically resulting from hormones changes, particularly in women (progesterone and estrogen), and sun exposure, about 9 of 10 people with melasma are women ages 20 to 50, according to dermatology specialist Romeo Morales, M.D., for Advanced Dermatology PC (multiple locations in NY and NJ).

Melasma is often referred to as the mask of pregnancy because its dark patches, which usually crop up on the nose, cheekbones, and jaw - are even more prevalent while women are expecting. But that doesn't mean women greet the development of these embarrassing spots with the same type of glee as they do their babies-to-be.

According to the National Institutes of Health, about 6 million women in the US are estimated to cope with melasma, which has no permanent cure but can be effectively treated. While hormonal changes and sunshine are the two biggest triggers, those with a genetic predisposition and darker skin are more prone to the condition. People who work around heat for example, such as cooks, may also be prone because of heat's ability to irritate the skin and induce overproduction of pigment. "Most women who come to me with melasma are dismayed at their appearance," says Morales. "Melasma is not dangerous, but there's no question that it detracts from their quality of life."


Best treatment options for melasma

Melasma can fade on its own, particularly when the trigger causing it, such as pregnancy or oral contraceptive use, ends. "With the help of a dermatologist, most melasma treatments result in good outcomes," says Morales. "Melasma can be stubborn and the topical treatments may take a few months to work, but patients are usually very happy with the results." There are several treatment options available, including:

  • Hydroquinone: Available in a cream, lotion, gel or liquid, this medication works by lightening the skin. Hydroquinone can be found in over-the-counter preparations, but higher strength versions can only be obtained through a doctor's prescription.
  • Tretinoin and corticosteroids: These medications enhance the skin lightening process when added to hydroquinone. Some contain three compounds - hydroquinone, tretinoin, and a corticosteroid, which are then called a triple cream.
  • Other topical medications: Also applied to the skin, these may include the skin-lighteners azelaic acid or kojic acid.
  • In-office procedures: When topical medications don't do the trick, dermatologists may use in-office procedures such as a chemical peel, microdermabrasion or dermabrasion treatment, which slough off the top layers of the skin. It should be noted that irritation itself could produce more pigment on the skin.


Prevention of melasma the best strategy

The catch? No melasma treatment offers permanent results, so Morales recommends maintenance therapy that can prevent melasma from coming back. . "Melasma may not be completely preventable, even with the best skin care and precautions," says Morales. "But in the vast majority of cases, efforts to prevent it or treat it are successful at keeping those annoying spots away." Certain common-sense tactics can also help avoid melasma from developing in the first place, including:

  • Daily sunscreen use: Since sunlight is one of the biggest triggers for melasma, daily sunscreen use is non-negotiable to keep it at bay. Choose a sunscreen with broad-spectrum protection with an SPF of 30 or higher.
  • Outdoor hats: Broad-brimmed hats help keep rays off vulnerable parts of the face. Seek shade whenever outdoors as well.
  • Gentle skin care: Since products that irritate the skin exacerbate melasma, use gentle products that don't sting or burn.


Romeo E. Morales, M.D., board certified in dermatology and specializes in clinical dermatology, skin cancer, and skin immunology.