To protect your skin from damage, melanin darkens.
In melasma, melanin darkens - but not in a good way.
Melanin is the pigment that gives skin its color. To protect your skin from damage, the melanin darkens. Any damage that occurs affects the top layer of the skin (the epidermis). Usually damage is a result of things like sun exposure, hormone changes and inflammation (acne breakouts, etc.). In melasma, this darkening accumulates with age, leaving stubborn dark spots that are deep in the dermal layer of the skin. Because they're deep, these discolorations can return, even after they have been treated.
Do lots of people have melasma? What does it look like?
Over 5 million Americans have melasma. It is a condition that usually affects areas of high sun exposure - the cheeks, forehead, upper lip, nose and chin. It causes symmetrical brown to gray-brown, flat patches on the face. These areas do not occur in the same places on everyone. One person may have it only on their cheeks and nose, while another person's melasma may overly the jaw. The neck and forearms can also be affected.
While we don't know what causes melasma, we do know some triggers:
- Intense, long-term exposure to sunlight worsens this skin condition and may trigger it. It is THE most important factor in the development of pigment. Because development of the discoloration is inconspicuous, people may not realize they have melasma. Summer sun exposure makes it worse and causes recurrences. Without strict avoidance of sunlight, potentially successful treatments will fail. Even a small amount of sun exposure can make melasma return.
- Any race can be affected by melasma, but people with dark skin (Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent) are more likely to have it. This type of hyperpigmentation is even more common in light brown skin types. It is estimated to affect 8.8% of Hispanic women in the United States and about 40% of Southeast Asian women.
- People with a relative who has melasma are more likely to get it - so there is probably a genetic component.
- Melasma predominantly affects women. It was once called "the mask of pregnancy” because 1/2 of all cases start during pregnancy. 90% of cases occur in women, especially during their reproductive years. These women develop progressive hyperpigmentation of the face which suggests a direct relationship with female hormones. Pregnancy-induced melasma usually fades within a year after delivery, while contraceptive-induced melasma continues as long as the contraceptive is used.
- Thyroid hormone may affect its development. People with melasma are four times as likely to have a thyroid abnormality than those with normal pigmentation.
- Over treatment can result in inflammation making it worse. Anything that causes heat or friction resulting in trauma can stimulate melanin production. This has been shown in many studies of intense pulsed light (IPL), laser, microdermabrasion and high percentage chemical peels.
How do doctors diagnose melasma?
Dermatologists can diagnose most patients by looking at their skin. A Wood's light lets the doctor see how deeply the pigmentation penetrates the skin. In many cases, pigment is found in both the epidermis (top layer) and the dermis (deep layer) of the skin.
How is it treated?
Many studies have shown that daily use of gentle, topical skin care products combined with professionally applied treatments are the best way to treat melasma. Learn more in our post, 11 Ways to Treat Melasma That Really Work!
6 Ways to Minimize Melasma:
1. Wear sunscreen daily. One of the most common treatments for this condition is sun protection. Since sunlight triggers melasma, it is important to wear sunscreen every day - even on cloudy days. Choose a broad-spectrum, SPF 30 or more sunscreen. The ingredients zinc oxide and titanium dioxide are great because they reflect the sun. Apply sunscreen 15 minutes before going outside and reapply at least every two hours. Powdered sunscreens make reapplication easier. A study of 200 Moroccan women who applied SPF 50+ sunscreen daily during pregnancy, found less than 3% developed melasma. Normally, 15-50% of women develop this "mask of pregnancy," so sunscreen may decrease the rates.
2. Wear a wide-brimmed hat and seek shade when you’re outside. Sunscreen alone won't give you the sun protection you need. Whenever possible, wear protective clothing and sunscreen. Long sleeved rash guards and SPF rated clothing work well.
3. Wear UV rated sunglasses. They protect your eyes and the skin around them from damaging rays.
4. Choose gentle skin care products that don’t sting or burn. Products that irritate may worsen hyperpigmentation by causing inflammation.
5. Avoid waxing. Waxing may cause skin inflammation which can worsen melasma. So avoid waxing any areas with dark spots.
6. For women, limiting estrogen exposure will help. This condition will continue while pregnant, breastfeeding or taking oral contraceptives. Learn more in our blog post, 19 Medications That Cause Dark Spots & Hyperpigmentation.
Melasma is persistent. It may take months of treatment to see improvement. Dark pigment develops gradually, so fading will also be gradual. People prone to hyperpigmentation will always be susceptible to recurrence. Strict sun avoidance combined with daily use of skin care products that stop pigment production is critical. Even though these things can be difficult, many people with this condition do get a good outcome.
Ready to learn more? Read our blog post, 10 Ways to Treat Melasma That Really Work and download our article, Melasma Skincare Products to Try - No Doctor Needed + When to Apply Them. It's in our Free Resource Library!
Amy Takken, RN
Amy Takken is a registered nurse with 20+ years of experience helping people improve their health. Her in-depth skincare articles have been featured on Nazarian Plastic Surgery and The Palm Beach Center for Facial Plastic & Laser Surgery. She's also been quoted on Dermascope.com.
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The Information provided on our website is not medical advice and should not be viewed as such. By law, only a medical doctor can diagnose or give medical advice. As a registered nurse, my goal is to educate, so I provide information on skin care, skin care products, and skin care treatments. If you have any condition that concerns you, please see a medical doctor. While most skin conditions are benign, some - like melanoma - can be deadly. If there is any doubt, please, please consult your physician. Thank you!