Melasma: What Is It? Why Do I Have It? And What Can I Do About It?

November 9, 2020


Dr. Keira Barr

Hormones are the architectures of our bodies.  And any changes in it’s level lead to physical changes in our bodies. But, the reproductive hormones rule the female physique. Besides shaping our bodies, these hormones also cause skin changes. We know about hormonal acne. The unfortunate burden of puberty. But, do you know about the skin changes that occur during pregnancy? And do we prepare ourselves for them? We know about that glow of pregnancy. But, do you know about the mask of pregnancy? About this veil known as melasma?

Melasma are blotchy patches of dark pigmentation occurring on the face. They can be found on the:

  • Forehead
  • Cheeks
  • Chin
  • Above the upper lip
  • Bridge of the nose

Although common in pregnant women, it is not limited to them. It appears in women going through menopause as well. For this reason, it is our symptom of the month. 

But before considering the treatment options availabe, we need to understand melasma. So, let us break it down.


Melasma affects 5 million Americans. And 90% of them are women. Nevertheless, men can have it too. Particularly, when it is hereditary. A study shows that 70% of Latino men with melasma also had a family member with it.

People with darker skin tones are more likely to have melasma. And that is because they have more active pigment producing cells. You are more likely to get melasma if your ancestry has the following origins:

  • Asian
  • Indian
  • Middle Eastern
  • Mediterranean
  • Latin/Hispanic
  • African-American
  • North African


The exact cause of melasma is unknown. However, the four primary influencers are:

  • Hormones
  • UV exposure
  • Inflammation
  • Genetics

Melasma formation is a game between hormones, cells, and pigments. Thus, the three key players are:

  • Melanocytes: The pigment-producing cells.
  • Melanin: The pigment.
  • MSH: The melanocyte-stimulating hormone.

In a nutshell, the hormone causes cells to produce more pigment, resulting in skin darkening.

I. Changes in hormonal levels

In a woman’s life, hormonal levels are changing. From puberty to pregnancy, and finally menopause. The primary hormone that drives these transitions is estrogen. And estrogen has an important connection with melanin. Progesterone does too but not as much. When these hormone levels are high, more melanin is present. Situations that stir hormones are:

  • Pregnancy
  • Menopause
  • Women taking oral contraceptives
  • Women on hormone replacement therapy (HRT)

Hormones and Stress

Stress affects hormones in many ways. To comfort our minds, we go for yoga or meditation. But our body copes by producing cortisol. Whether it is physical or emotional stress, cortisol is present. But, how does cortisol fit into this equation? Well, more cortisol creates an imbalance in estrogen levels. And when there is more estrogen, there is more MSH. And this means more melanin. For this reason, one key to restoring hormonal balance is to manage stress.

The Thyroid Hormone

Thyroid hormone imbalance also causes skin darkening. Particularly, autoimmune thyroid conditions. Research shows that those with thyroid disorders have a higher incidence of melasma.

II. The role of sunlight and heat

We all know that being in the sun for a long time results in a sunburn. What’s more? UV light also increases melanin production. This is why melasma often worsens during summers.

 There is always a chance that melasma will return, in spite of all your efforts. Because even with a little exposure, it can come back.

The heat of the sun plays a role too. Heat, of any kind, causes skin darkening. Because heat increases blood flow to the dark areas of the skin. Heat also increases inflammation, triggering the release of MSH. And we know what excess MSH does; increase pigment production!

 The conclusion? Protect your skin from sunlight!


Melasma is a chronic condition. It is not painful or uncomfortable. Additionally, it is not cancererous. So, why do we care so much about it? Although it is a benign condition, it does have some consequences. Because living with melasma can impact mental health. Studies reveal an association of melasma with depression and anxiety. Since it heavily impacts self esteem, melasma can also result in poor quality of life. For this reason, many of us want to treat melasma. 


Your dermatologist will diagnose melasma by looking at your skin. But, to confirm, they may do a Wood’s light test. In this test, a small device uses a black light to light up areas of dark skin. It is also crucial to know the depth of melasma. That is, how far the pigmentation extends into the skin. Because, the deeper it extends, the harder it is to treat.

Melasma can also mimic other skin conditions. In that case, your dermatologist may do a skin biopsy. A skin biopsy is a simple procedure. It is safe and quick. And all it takes is an office visit.


With time, melasma can go away on its own. For instance, melasma fades after childbirth when pregnancy hormones calm down. Or the dark patches fade when a woman stops taking hormonal medication. But the fading process will take its sweet time. And the patches can last for many years.

But following the below tips can speed up its departure. These tips will also prevent reoccurrence.

Visit your Doctor

Some medical conditions can cause melasma. These include:

  • Thyroid diseases
  • Hormonal imbalances
  • Allergic reactions

Treating these underlying condition will clear melasma. Thus, it is essential to visit your doctor. Especially when you are doubtful of any dark patches on your face.

Limit sun exposure

When going out:

  • Wear a broad-brimmed hat.
  • Cover your eyes with sunglasses.
  • UV rays also penetrate window glass; whether you are indoors or in your car.

Do not forget to put on SPF 30 broad-spectrum sunscreen daily.  For most skin types, physical sunscreens such as zinc oxide are better. That is because they are less irritating.

Protect with good nutrition

For a healthy mind and body, well-balanced nutrition is vital. Good nutrition will also improve your sun protection efforts. To stop inflammation, following an anti-inflammatory diet is necessary. So fill up your plate with colorful fruits and vegetables! And do not forget to include healthy fats like olive or avocado oil.

Supplements that boost UV protection are:

  • grape seed extract
  • green tea extract
  • omega-3 fatty acids

Topical treatments

  • Hydroquinone is the first choice of treatment. But, long-term use can cause blue-black discoloration of the skin (ochronosis). Thus, apply it less often.
  • Tretinoin and corticosteroids are present in a triple cream. This triple cream also contains hydroquinone. Hydroquinone and tretinoin do the job of skin lightening. Whereas, corticosteroid soothes irritation from other ingredients.
  • Kojic acid is present in mushrooms. And is also a byproduct of fermented foods (soy sauce, rice wine). Tyrosine is needed to produce melanin. And kojic acid blocks it’s formation. So, when there is no tyrosine, there is no melanin. But, there is a risk of contact sensitivity with kojic acid. Thus, use sparingly because it can worsen melasma.
  • Azelaic acid works like hydroquinone. Using it with tretinoin will also enhances its effects. A plus point of azelaic acid? It is safe to use during pregnancy!
  • Vitamin C prevents skin damage by UV radiation. The best part? It is tolerable. You can use it alone or in combination with other topical therapies.
  • Niacinamide is an active form of vitamin B3. It stops the transfer of skin pigment from the deep layers of the skin to the top layer. It has anti-inflammatory effects. Moreover, it also makes the skin barrier function better.

These treatments work better with chemical peels. But, one should apply peels and topical therapies according to their skin type. For safe results, use these therapies under your dermatologist’s help. 

Cosmetic treatments (micro-needling, laser, microdermabrasion etc) may also worsen melasma. Thus, only professionals should do such treatments. Not adjusting these treatments according to the skin type will create new skin problems. 


  • Choose skincare products wisely. Because some products can worsen melasma. Go for products that are gentle on your skin. Drop products that are irritating.
  • Some cosmetic procedures can also worsen melasma. The heat, friction, or trauma from these procedures increase pigment production. These procedures have an association with melasma.
  • Avoid tanning beds.
  • Avoid waxing the affected areas. Ask your dermatologist about other suitable types of hair removal methods.


Tackling melasma is frustrating. And experiencing it the first time can be scary and confusing! But there are effective solutions for melasma. So keep at it. Persist with patience.