What Causes Melasma and Hyperpigmentation?

Melasma is a benign skin condition characterized by excessive pigment deposition in the skin. Hyperpigmentation is generally diffuse in the area of the upper cheeks, forehead, and jawline.
The top 4 causes of melasma are as follows:

Hormones (Estrogen, Progesterone)
Genetics
Sun Exposure
Inflammation of the skin

Treatment is based on reducing the production of pigment in the melanocytes. Although there are several alternative natural treatments, the most effective are the following:

Hydroquinone
Chemical peels
IPL
Fractionated Laser (Fraxel)

However, be careful as the last three treatments, although effective, can actually worsen the melasma if not done by an experienced physician.

Pigmentation/melasma can be a result of multiple different factors including genetics, sun damage, etc. Pigmentation  needs a combination approach of peels like cosmelan, lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection. Bi-monthly facials with silk peel dermal-infusion are also essential to hydrate, exfoliate, and infuse vitamins and antioxidants into the skin. If you have acne you can do additional treatments and peels to get more improvement. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Melasma is caused when melanocytes in the skin produce too much pigment creating brown or grey-brown patches on the face.  Exacerbating factors that cause melanoctyes to produce pigment include:-sun exposure- UV light can cause melanocyte to produce melanin-hormonal changes- pregnancy and birth control pills as well as hormone replacement can trigger melasma-inflammation or irritation- heat exposure, cosmetics, or other inflammatory conditions can exacerbate the condition.

Melasma can be treated the most effectively with the following:
Hydroquinone
Chemical peels
IPL
Fractionated Laser
As the other physicians have mentioned, however care and consideration must be used for patients with darker skin types as hypopigmentation may occur, creating a whole separate problem.
Consult a board certified dermatologist or plastic surgeon.
Good luck!

Brown spots on the skin—typically on the face, chest, shoulders, and back of hands—can be the direct result of unprotected exposure to the sun. They can also be a result of hormonal changes and are a common skin problem that we, consult many of our patients about.
The flat spots on the skin—also called age spots, sun spots, solar lentigines, or liver spots (even though they have nothing to do with the liver)—are triggered after prolonged sun exposure. When the sun’s UV rays hit the skin, they damage the pigment-producing cells called melanocytes and causing a spike in production of the skin pigment called melanin. They’re common in patients with fair skin, but they can also appear in those with darker skin.
These spots range in color from brown to tan to dark brown based on how much sun exposure you’ve had—and cause your skin to look blotchy, freckled, and uneven. And they vary in size, again depending on how much sun you’ve been exposed to.
Link to hormones: As hormone levels may change during events such as pregnancy or due to birth control pills, brown, uneven patches can appear on a woman’s face when the skin is exposed to the sun. It seems that sunlight triggers the pigment-producing cells in the skin to go into overdrive. Called the melasma, these dark patches may persist and not improve even with bleaching creams.
We commonly treat these brown spots or patches with chemical peels (which exfoliate the outermost layer of skin, removing the dark spots), light therapy and lasers (the energy blasts away pigment).

Causes of Melasma?
Hormones, hormones, hormones!!
Genes, Inflammation, UV B more than UV A rays.
Best treatment for Melasma currently is Halo Hybrid Fractional Laser.  It is safe and effective for all skin types.
Occasionally, IPL may worsen melasma.
Certain peels and microneedling may also help the superficial layer pigments but it will not help the pigments in the deeper layers of your skin.
Hope this gives you some insight.
Best wishes,
Dr B

Melasma is a splotchy light or dark brown discoloration that occurs on the face and neck—most commonly on the cheeks, forehead, upper lip and chin. It tends to occur in women who are pregnant or taking oral contraceptive pills and who live in sunny areas. However, it may occur in the absence of these factors, and it is sometimes seen in men. People with darker skin tone (those of Latin, Asian, Indian, Middle Eastern, Mediterranean, and North African descent) are more likely to develop Melasma. The pigment develops slowly over time, with no signs of inflammation or irritation. The exact cause is unknown but hereditary, hormones, and sunlight exposure are certainly important factors.

The single most important thing you can do is protecting yourself from the sun. Sunlight will gradually cause darkening of the pigment. This is because the pigment-producing cells in the skin called melanocytes that are responsible for Melasma are stimulated by the sun’s UV rays. Even when it is cloudy outside, the sun’s rays can penetrate the skin. For daily use, select a facial moisturizer with sunscreen that offers “broad-spectrum protection (covers both UVA and UVB) with at least SPF 45 or more. If you plan to be outside for a
significant period of time, wear a hat!

Beyond sun avoidance, there are several other treatment options for melasma.  Bleaching cream called hydroquinone (used in combination with retinoids and corticosteroids) may help to lighten the skin.  It often can take several months to notice an improvement.  For patients who desire quicker results, or who have already tried bleaching cream, I recommend treatment with either chemical peels, IPL, or Fraxel Laser. 

As you can see, treating melasma is complex and multiple treatment modalities are often necessary including sunscreen, bleaching cream, peels, and laser treatments. While melasma is difficult to treat, we have had great success treating many of our patients. Being under the care of a dermatologist helps many people achieve a successful outcome.

Melasma is also known as the "mask of pregnancy." Its causes, as mentioned include:
1. Hormones including estrogen and fluctuations in hormone levels)
2. Genetics
3. Sun Exposure
4. Inflammation or irritation
5. Heat (this is one factor that I threw in because it seems that individuals in warm environments, for example cooks seem to be more prone to developing melasma, though it may be related to #4).
The first two factors I listed are difficult to address (though certain hormone-altering medications such as spironolactone might be useful).
Sun avoidance/sun protection and sunscreen use, daily is probably the most important intervention you could do for melasma. A broad spectrum sunscreen with titanium dioxide, zinc oxide or avobenzone is suggested. If you do not pay attention to the sun factor, you can treat melasma all you like and it will simply recur.
Interventions that can help; hydroquinone (e.g. Triluma), a series of light chemical peels, azelaic acid, IPL, Fraxel. Cosmelan is a somewhat of a "do-it-yourself" kit containing skin lightening agents other than hydroquinone such as kojic acid and vitamin C, and can be quite effective.
Good Luck.