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Melasma

(Chloasma)

By

Shinjita Das

, MD, Harvard Medical School

Medically Reviewed Oct 2022
VIEW PROFESSIONAL VERSION
Topic Resources

Melasma is dark brown patches of pigmentation that appear on sun-exposed areas of the skin, usually the face.

  • Patchy areas of dark color appear on the skin.

  • Doctors usually base the diagnosis on an examination of the skin.

  • Treatment includes sun protection and skin-bleaching creams.

People who spend a lot of time in the sun are at increased risk of melasma. Other risk factors include autoimmune thyroid disorders and drugs that make some people's skin more sensitive to the effects of sunlight.

Symptoms of Melasma

Irregular, patchy areas of dark color appear on the skin, usually on both sides of the face. The pigmentation most often occurs in the center of the face and on the cheeks, forehead, temples, upper lip, and nose. Sometimes people have the patches only on the sides of the face. Rarely, melasma appears on the forearms. The patches do not itch or hurt and are only of cosmetic concern.

Diagnosis of Melasma

  • A doctor's evaluation

  • Wood light examination

Doctors base the diagnosis of melasma on an examination of the skin.

Treatment of Melasma

  • Skin-bleaching creams

  • Sometimes chemical peels or laser treatments

  • Sun protection

Treatments applied to the skin are effective only if hyperpigmentation affects the upper layers of the skin. Skin-bleaching creams containing hydroquinone, tretinoin, or a corticosteroid can be used in combination to help lighten the dark patches. However, hydroquinone should be used only under the guidance of a doctor, because long-term use can sometimes cause a permanent form of hyperpigmentation. A cream containing azelaic acid can be used in place of or combined with hydroquinone, tretinoin, or both.

Doctors may try chemical peels with glycolic acid or trichloroacetic acid on people who do not respond to skin-bleaching creams.

During pregnancy, azelaic acid cream and chemical peels with glycolic acid are safe to use. Hydroquinone and tretinoin are not safe to use.

Laser treatments and tranexamic acid, which is a drug taken by mouth, are also used.

During and after treatment, people must be strict about sun protection because treatments make the skin prone to sunburn. Also, even a few hours of sun exposure can cause hyperpigmentation to begin again in the treated areas, which would undo the results of months of treatment.

People with melasma should use sunscreens Sunscreens Sunburn results from a brief (acute) overexposure to ultraviolet (UV) light. Overexposure to ultraviolet light causes sunburn. Sunburn causes painful reddened skin and sometimes blisters, fever... read more Sunscreens with a sun protection factor (SPF) of 30 or higher, wear protective clothing Clothing Sunburn results from a brief (acute) overexposure to ultraviolet (UV) light. Overexposure to ultraviolet light causes sunburn. Sunburn causes painful reddened skin and sometimes blisters, fever... read more Clothing , and avoid sun exposure Avoidance Sunburn results from a brief (acute) overexposure to ultraviolet (UV) light. Overexposure to ultraviolet light causes sunburn. Sunburn causes painful reddened skin and sometimes blisters, fever... read more Avoidance to prevent the condition from getting worse. Most chemical sunscreens protect the skin from ultraviolet light but not from visible light. People should use a tinted sunscreen that also contains zinc oxide or titanium dioxide, which are natural minerals that provide a physical block against visible light. For greater protection, people can use a sunscreen that contains both minerals and antioxidants. For even more protection, people can take the dietary supplement Polypodium leucotomos by mouth.

If the skin is protected from the sun, melasma often fades after pregnancy or after an oral contraceptive is stopped. In men, melasma rarely fades.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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