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Melasma Can Be Hard to Treat, but It’s Not Impossible

Posted by Kenne Ogunmakin, M.D. on Feb 23, 2019 8:48:00 AM

From acne to psoriasis, it’s estimated that more than 100 million Americans are fighting at least one type of skin condition. One common condition I see, especially in women, is melasma, which appears as dark brown and gray patches, most notably on the forehead, upper lip, nose and cheeks.  

Melasma Can Occur at Any Age

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Melasma is a form of hyperpigmentation, a broad term that refers to the darkening of the skin. It generally starts between the ages of 20 and 40 years but can begin in childhood or not until middle age. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes. Lifelong sun exposure causes a buildup of pigment within the dermis. Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes to produce more melanin. 

People with darker skin, such as those of Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, or Mediterranean descent, are more likely to get melasma.  

Melasma can be triggered by: 

  • Sun exposure and sun damage.
  • Pregnancy: Commonly described as “pregnancy mask,” melasma appearing during pregnancy often fades a few months after delivery.
  • Hormone treatments, including oral contraceptive pills that contain estrogen and/or progesterone, hormone replacement, intrauterine devices, or implants.
  • Certain medications.
  • Thyroid abnormalities.

How Melasma Is Diagnosed

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Signs of melasma are brown or gray-brown patches on the face – on the cheeks, forehead, bridge of the nose, chin, or above the upper lip.

Dermatologists can diagnose most patients by looking at their skin. To see how deeply the melasma penetrates the skin, your dermatologist may look at your skin under a Wood’s light. Rarely, a skin biopsy may be performed during an office visit to confirm the diagnosis of melasma, which can sometimes look like other skin conditions. 

Why It Can Be Difficult to Treat 

Melasma can be slow to respond to treatment, especially if it has been present for a long time. Treatment options usually include topical medications and procedures. There are several effective procedural options, including chemical peels, lasers, microneedling, and PRP (platelet-rich plasma therapy). The treatment plan is customized to every individual based on skin type. Though there are several effective treatment options, at times treatment may be challenging if the pigment is deep in the skin. The medicines and devices that are used can only penetrate so far and may not reach deeply enough for good treatment results. Even when melasma treatment is successful, without a commitment to sun protection it can return. It may take a few months of treatment to see improvement. It’s important to follow your dermatologist’s recommendations to get the most benefit from treatment and help avoid skin irritation and other side effects.  

Prevention Is Key 

The easiest way to prevent many cases of melasma is by protecting your skin from the sun. Wear sunscreen with broad-spectrum protection with at least SPF 30 religiously. Apply it before you leave the house and take it with you, so you can reapply throughout the day. Wear a wide-brimmed hat for added coverage. 

Ogunmakin, KenneDr. Ogunmakin is a board-certified Dermatology specialist at Kelsey-Seybold’s Tanglewood Clinic. She cares for patients of all ages, and her clinical interests include skin of color, hair loss, medical dermatology, dermatologic surgery, and laser and cosmetic surgery.


Topics: what causes melasma, how is melasma treated, prevent melasma, melasma

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