Melasma: Causes, Symptoms & Treatment Options

Melasma is a common pigmentation disorder that causes brown, grey-brown, or blue-grey patches on the face. It affects millions of people, predominantly women, and is especially common in people with darker skin tones. While it's not harmful, melasma can have a significant impact on self-confidence.

What Does Melasma Look Like?

Melasma presents as symmetrical, irregularly shaped patches of discolouration, most commonly on the:

• Cheeks
• Forehead
• Bridge of the nose
• Upper lip (sometimes called "melasma moustache")
• Chin
• Occasionally forearms and neck

What Causes Melasma?

Melasma occurs when melanocytes (pigment-producing cells) become overactive and produce excess melanin. The exact mechanism isn't fully understood, but several triggers are well-established:

1. Sun Exposure

UV radiation is the single most important trigger. Even brief sun exposure can worsen existing melasma and trigger new patches. UVA rays penetrate deep into the skin, stimulating melanocytes. Visible light (especially blue light from screens) can also trigger melasma in darker skin tones.

2. Hormonal Changes

Melasma is often called the "mask of pregnancy" because it frequently develops during pregnancy due to elevated oestrogen and progesterone levels. Oral contraceptive pills and hormone replacement therapy are also common triggers.

3. Genetics

If you have a family history of melasma, you're more likely to develop it. Studies show that 40–60% of melasma patients have a positive family history.

4. Heat

Infrared radiation and heat (including cooking heat, hot environments, and saunas) can worsen melasma independently of UV exposure.

Types of Melasma

Melasma is classified based on the depth of pigment:

• Epidermal: Brown colour; pigment is in the upper skin layer; responds best to treatment
• Dermal: Grey-blue colour; pigment is deeper in the dermis; more resistant to treatment
• Mixed: Combination of both; most common type

A Wood's lamp examination by a dermatologist helps determine the type and guides treatment selection.

Treatment Options

Topical Treatments

• Hydroquinone (2–4%): The gold standard depigmenting agent; lightens skin by inhibiting melanin production
• Tretinoin (Vitamin A): Increases cell turnover, helping to remove pigmented cells faster
• Azelaic Acid: Reduces melanin production; safe for long-term use and during pregnancy
• Vitamin C: Antioxidant that inhibits melanin synthesis and protects against UV damage
• Triple Combination Cream: Hydroquinone + tretinoin + corticosteroid — the most effective topical combination

Procedural Treatments

• Chemical Peels: Glycolic acid, lactic acid, or mandelic acid peels help remove superficial pigment
• Microneedling: Creates micro-channels for better penetration of depigmenting agents
• Laser Toning: Low-fluence Q-switched Nd:YAG laser can gradually reduce pigment
• Tranexamic Acid: Oral or intradermal — reduces melanin transfer and inflammation

Sun Protection (Essential)

No treatment will work without strict sun protection. Use a broad-spectrum SPF 50+ sunscreen, reapply every 2–3 hours, wear wide-brimmed hats, and avoid peak sun hours.

Can Melasma Be Cured?

Melasma is a chronic condition that can be effectively managed but not permanently cured. With the right combination of treatments and sun protection, significant improvement is possible. However, maintenance therapy is usually needed to prevent relapse.