Melasma
Melasma — a common form of hyperpigmentation that appears as symmetrical brown or grayish-brown patches, most often on the cheeks, forehead, upper lip, and bridge of the nose. It is driven by increased melanin production and is strongly linked to sun exposure and hormonal changes.
Key points
- Melasma is more common in women and often triggered by pregnancy, hormonal contraceptives, or hormone fluctuations.
- Sun exposure and visible light are major aggravating factors, making daily broad-spectrum sun protection essential.
- It tends to be chronic and recurring, and can be persistent even with treatment.
- Ingredients studied for melasma include vitamin C, niacinamide, and prescription options managed by a professional.
Patterns and depths
| Type | What it looks like | What it responds to |
|---|---|---|
| Epidermal | Mid-brown, fairly defined edges | Most responsive; topicals plus strict protection over 3–6 months |
| Dermal | Ashen or blue-grey, blurred edges | Little topical response; focus shifts to prevention |
| Mixed | Brown and grey within one patch | Partial — the brown lightens first, the grey lags |
| Centrofacial | Forehead, upper lip, nose, cheeks | Broad-spectrum plus visible-light cover; seasonal recurrence usual |
| Malar | Cheeks and upper cheekbones | Same measures; fluctuates most with hormonal change |
| Mandibular | A band along the jawline | Slow; usually carries a photodamage component |
| Extrafacial | Forearms, neck, upper chest | Least responsive; shade and clothing do the work |
Why the pigment sits where it does
The route from stimulus to visible brown — pigment cells building melanin and passing it upward — is set out under dark spots. What distinguishes melasma is which stimuli those cells answer to: ultraviolet, but also visible light, particularly the blue-violet HEV end, and infrared heat. Hence patches that deepen through a car window, and hence tinted sunscreens, whose iron oxides absorb visible light where transparent filters do not.
Depth is the other half. Pigment held mainly in the epidermis reads brown and fairly well edged; pigment that has dropped into the dermis reads grey and blurred; most cases are mixed. Beneath a patch the skin often shows more vessels and a disrupted basement membrane, letting melanin fall where no topical reaches. The drivers outlast the colour, so melasma is managed, not cured.
What genuinely helps, and the honest timeline
Photoprotection does more work than everything else combined: broad-spectrum sunscreen daily and reapplied, tinted with iron oxides to cover visible light, plus shade and less direct heat on the face. Topicals with reasonable evidence include azelaic acid at 10–20%, niacinamide at 4–5%, vitamin C at 10–20%, topical tranexamic acid, cysteamine and thiamidol. Judge at 3–6 months, not before 8–12 weeks.
Restraint outperforms intensity here: scrubs, enthusiastic peels and aggressive resurfacing can leave inflammatory pigment and a rebound darker than the start. Prescription routes work mechanistically — hydroquinone suppresses tyrosinase, the enzyme that begins melanin synthesis, and oral tranexamic acid acts upstream on plasmin-driven stimulation. Both are selected, dosed and withdrawn by a clinician.
When to involve a clinician
Ask for a review if three months of consistent protection and a properly used routine have changed nothing; the pigment may sit deeper than topicals reach, or may not be melasma. Go sooner if pigmentation is one-sided, forms a single discrete lesion, is raised or textured, or changes in size, shape or colour, bleeds or does not heal.
Melasma often appears or deepens in pregnancy and frequently lightens over the year that follows, though rarely completely. Which ingredients suit pregnancy or breastfeeding belongs with your midwife, obstetrician or doctor. Pigmentation arriving with fatigue, weight change or darkening of scars, gums or palm creases deserves review for a systemic cause; distress alone also justifies a referral.
Frequently asked
What triggers melasma?
Melasma is commonly triggered by sun exposure and hormonal changes such as pregnancy or hormonal contraceptives, often on a background of genetic predisposition.
Why is sunscreen important for melasma?
Sun and visible light stimulate the pigment production that drives melasma, so consistent broad-spectrum protection is a key part of managing and preventing it from worsening.
Will melasma fade on its own?
Sometimes, partly. Pigment that arrived in pregnancy often lightens in the months after delivery, and pigment linked to hormonal contraception may ease if that changes, which is the prescriber’s call. Melasma driven mainly by sun exposure usually persists.
Can melasma come back after it has faded?
Yes, and commonly. Those pigment cells go on over-responding to light, heat and hormonal signals after the colour has gone, so a summer or a pregnancy can bring the patches back.
Does heat make melasma worse even out of direct sun?
Infrared and plain warmth seem to contribute independently of ultraviolet, so patches can deepen near an oven, a fire or a sauna. Heat is rarely the main driver.
Is melasma the same thing as sun spots?
No. Melasma forms broad, symmetrical, soft-edged patches that fluctuate with hormones, light and heat, while solar lentigines are small, discrete, stable spots on skin with years of accumulated exposure.
Related topics
This is a foundational entry in the SYNC Skin Encyclopedia and is expanded over time. Educational information only — not medical advice.
