Signs and Symptoms

Melasma is a common skin problem. It causes brown to gray-brown patches, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck. One of the most common treatments for melasma is sun protection. This means wearing sunscreen every day and reapplying the sunscreen every 2 hours. We also recommend wearing a wide-brimmed hat when you are outside. Sunscreen alone may not give you the protection you need. Women are far more likely than men to get melasma. It is so common during pregnancy that melasma is sometimes called “the mask of pregnancy.” Hormones seem to trigger melasma.

Common signs of melasma are brown or gray-brown patches on the face. These patches most commonly appear on the Cheeks, Forehead, Bridge of the nose, above the upper lip and Chin. Some people get patches on their forearms or neck. This is less common. Melasma does not cause any symptoms.

People with darker skin are more likely to get melasma. People who have a blood relative who had melasma also are much more likely to get melasma.

What causes melasma is not yet clear. It likely occurs when the color-making cells in the skin (melanocytes) produce too much color. People with skin of color are more prone to melasma because they have more active melanocytes than people with light skin.

Common melasma triggers include:

Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. In fact, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma often is worse in summer. It also is the main reason why many people with melasma get it again and again.

A change in hormones: Pregnant women often get melasma. When melasma appears in pregnant women, it is called chloasma, or the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma.

Skin care products: If a product irritates your skin, melasma can worsen.

Tips For Management

Although the exact causes of melasma are unclear, common triggers include sun exposure, pregnancy, birth control pills and cosmetics.

(1) Wear sunscreen daily: One of the most common treatments for melasma is sun protection every day, even on cloudy days and after swimming or sweating. Choose a sunscreen that offers broad-spectrum protection, a Sun Protection Factor (SPF) of 30 or more, and zinc oxide and/or titanium dioxide to physically limit the effects of the sun’s rays on your skin. Apply sunscreen 15 minutes before going outside and reapply at least every two hours.

(2) Wear a wide-brimmed hat and sunglasses when you’re outside.

(3) Choose gentle skin care products, that don’t sting or burn, as products that irritate the skin may worsen melasma.

(4) Avoid waxing, as waxing may cause skin inflammation which can worsen melasma. 

Treatments for Melasma

Melasma can fade on its own. This usually happens when a trigger, such as a pregnancy or birth control pills, causes the melasma. When a woman delivers her baby or stops taking the birth control pills, melasma can fade.

Available treatments are:

Hydroquinone is a common first treatment for melasma. It works by lightening the skin. 

Tretinoin and corticosteroids, to enhance skin lightening.

Other topicals may include azelaic acid or kojic acid to help lighten melasma.


Procedures for melasma include a chemical peel, microdermabrasion and Laser treatment.