What Causes Melasma and Hyperpigmentation?

What causes melasma, and what sort of melasma treatment is available?

Doctor Answers 5

Top 4 Causes of Melasma

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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.

Melasma's causes are several

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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.

Bryan K. Chen, MD
San Diego Dermatologist

Melasma - skin types

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Melasma can be treated the most effectively with the following:

Chemical peels
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!

Causes of Melasma

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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.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 171 reviews

Melasma Treatments

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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.

Margaret Mann, MD
Cleveland Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.