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Many of my patients, particularly women aged 20 to 50, are concerned about the same thing – a “mask” of mottled skin on the tops of the cheeks and temples. This common (and benign) condition is called melasma, a Greek derivation meaning “dark pigmentation of the skin.” Melasma can happen to anybody, but it is more common among darker-skinned people and those who tan easily.

Ninety percent of cases occur in women because female hormones are a major contributing factor. As a result, it may start or worsen during pregnancy or with the use of birth control pills. While the discoloration usually appears on the face, it can also develop on the neck and forearms. Aside from hormonal causes, melasma is also triggered by sun exposure.

Melasma occurs in 3 forms – epidermal (at the top layer of skin), dermal (at the second layer), or mixed. Epidermal melasma is easier to treat than dermal melasma, which often doesn’t respond or reappears after treatment.

My patients want to learn more about treatments for melasma because the condition is so highly visible. Before discussing treatment options, I first need to minimize hormonal or sun exposure that is aggravating the condition.

If my patient is on birth control pills or other hormonal therapies, I recommend stopping the medication with her doctor’s approval. Sometimes that’s enough to reverse the case. If my patient is pregnant, I recommend waiting it out. The condition is not harmful, and we would not want to start a course of treatment during pregnancy. Quite often, pregnancy-related melasma resolves on its own over time.

Treatment for melasma requires a strict regimen of high-SPF sunblock protection, protective clothing such as wide-brimmed hats, sun avoidance, and using an ultraviolet coating on car windows to reduce UVA exposure. I know staying in the shade or indoors during peak sun hours may be tough, particularly for those who are very active, but keep in mind that sun exposure makes melasma worse.

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Because melasma is common and causes characteristic brown patches on the face, dermatologists diagnose most patients by looking at their skin. Occasionally, a skin biopsy is necessary to confirm that the brown patches are melasma.


Sometimes melasma fades on its own. This is especially true after a pregnancy or when a woman stops taking birth control pills. If the melasma does not gradually fade or a woman wants to continue taking birth control pills, melasma can be treated.

A variety of creams are available to treat melasma. An active ingredient in these creams may be hydroquinone, a commonly used skin-lightening agent. If you notice irritation or darkening of the skin with a skin-lightening cream, consult your dermatologist immediately.

A dermatologist may prescribe a cream with a higher concentration of hydroquinone. A dermatologist also may prescribe creams containing tretinoin, corticosteroids, or glycolic acid, which may be combined with hydroquinone to enhance the skin-lightening effect. Another active ingredient that is being used to treat other conditions but also can help fade melasma is azelaic acid. Kojic acid may also help fade melasma.

A chemical peel, microdermabrasion, or laser surgery also may be used to treat melasma.

These can be successful, but these procedures should be performed by a dermatologist. Complications can occur when the procedure is not tailored to the patient's skin type.

It may take several months to see substantial improvement. It is important to carefully follow your dermatologist's directions during this time to ensure maximum benefit from the treatment. This also will help avoid skin irritation and other side effects.

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