Melasma: What is it and what can I do about it?

Melasma is a common skin condition in adults in which light to dark brown or greyish patches of pigmentation develop mainly on facial skin.  It is most common in women, especially during pregnancy.  However, it can affect men (up to 10% of people with melisma are male).  It usually becomes more noticeable during Summer months (due to sunlight) and improves during Winter months.  It is not an allergy.  It is not caused by a particular food type.  It is not contagious and it does not develop into cancer.

The exact cause of melisma is not known, but it is thought that it is related to hormones, including the contraceptive pill and pregnancy hormones.  Sunlight worsens it.  It is not hereditary although it tends to be worse in family members.

The affected skin is not sore or itchy, but because it appears on the face and is visible to others it can be upsetting and affect quality of life.

Melasma cannot be cured but there are treatments available for it.  If melisma occurs as a result of pregnancy it may very well resolve all by itself and no treatment may be necessary.

How can melisma be treated?

  • Avoiding trigger factors such as the contraceptive pill
  • Avoiding the sun: Skin affected by melisma darkens more than surrounding skin with exposure to sunlight, so sun avoidance and sun protection are important. Use a sunblock with SPF 30 at a minimum.  Check that your sunscreen protects against UVA and UVB.  Sunscreen should carry the UVA circle logo and/or 4 or 5 UVA stars to demonstrate that it protects against UVA.  Remember, no sunscreen will offer 100% protection against the sun.
  • Keep away from sunbeds.
  • Chemical peels can improve melasma. They do this by removing the outermost layer of skin cells that contain the excess pigment.
  • Certain skin-lightening creams can reduce the activity of pigment-forming cells in the skin. The most commonly used of these is hydroquinone.  Hydroquinone can only be prescribed by a doctor.  It must be used with care to ensure that it doesn’t irritate the skin and that there isn’t excessive lightening of the skin.  A word of caution: hydroquinone can occasionally cause darkening of the skin, especially in dark-skinned people.
  • Vitamin D: The evidence relating to Vitamin D and sun avoidance remains inconclusive.  Avoiding all sunlight may lead to Vitamin D deficiency.  If you avoid all sunlight, you may wish to have your Vitamin D levels measured.  If your Vitamin D level is reduced or deficient, you may need to consider Vitamin D supplementation.
  • Ask your doctor. It is recommended that you speak to your doctor if you notice changes to a patch of skin or a mole.  If necessary, your doctor can refer you to a Consultant Dermatologist for further assessment.