Melasma !

Melasma is a common, harmless condition that causes symmetric brown patches on the face, often linked to sun, pregnancy or hormonal contraceptives.

Updated 2026-11-01

Structures involved

Tap one to see what it is and open it in 3D.

Why it happens

What it is

An acquired, chronic and relapsing disorder of pigmentation that produces symmetric, light-to-dark brown macules and patches on sun-exposed areas of the face. It is benign and not contagious, but it often has a large impact on quality of life.

Who gets it

Very common in women of reproductive age with intermediate skin types (Fitzpatrick III–V), which describes much of the population of Colombia and Latin America; around 90% of patients are women. High ultraviolet and visible-light exposure in tropical and Andean cities adds to the burden. It also occurs in men, especially those with a family history.

Causes

Ultraviolet radiation and visible (blue) light, the main triggers and the reason it relapses
Female hormones: pregnancy (chloasma or 'mask of pregnancy'), combined hormonal contraceptives and hormone therapy
Genetic predisposition; a family history is frequent
Other contributors: some photosensitising drugs and cosmetics, heat, and thyroid autoimmunity in some series

Risk factors

Female sex and reproductive age
Intermediate to darker skin types
Pregnancy or use of oral contraceptives
Intense sun exposure without protection
Family history of melasma

Pathophysiology

Melanocytes in affected skin are hyperactive rather than increased in number. Ultraviolet and visible light, oestrogen and progesterone signalling, and chronic photodamage of the dermis (more blood vessels, damaged basement membrane, activated fibroblasts) stimulate melanin production. Pigment is deposited in the epidermis and, in many patients, also in dermal macrophages (melanophages), which makes it harder to treat.

Classification

By distribution: centrofacial (forehead, cheeks, upper lip, nose, chin; the most common), malar, and mandibular; extrafacial forms on the forearms
By depth: epidermal (better defined, accentuated under Wood's lamp), dermal (bluish-grey, not accentuated) and mixed (the most frequent)

Symptoms and signs

Symmetric light-to-dark brown patches with irregular, map-like borders
Typical sites: cheeks, forehead, upper lip, nose and chin
No itch, pain or scale
Darkening in summer, after sun exposure or during pregnancy
Emotional distress and reduced self-esteem

Diagnosis

Clinical: Clinical: symmetric brown facial patches in a typical setting (woman, sun exposure, pregnancy or hormonal contraception). Wood's lamp helps estimate depth, and dermoscopy shows a brown reticular network and can exclude other pigmented lesions.
Tests: No routine laboratory tests. Thyroid function may be checked when symptoms suggest thyroid disease. Biopsy only if the diagnosis is uncertain or a lesion looks atypical.
Imaging: Not needed. Standardised photographs are used to follow response.

Differential diagnosis

Post-inflammatory hyperpigmentation (after acne, eczema or procedures)
Solar lentigines and ephelides (freckles)
Drug-induced pigmentation and pigmented contact dermatitis
Acquired dermal melanocytosis (Hori nevus) and nevus of Ota
Lentigo maligna (asymmetric, single lesion)

Goal of treatment

Lighten the patches, prevent relapse by strict protection from ultraviolet and visible light, and remove triggers where possible; patients are told that melasma is chronic and control, not cure, is the realistic goal.

Treatment

Lifestyle: Daily broad-spectrum, tinted sunscreen (iron-oxide tints block visible light), reapplied often, plus hats and shade; this is the cornerstone of every plan.
Medical: Topical depigmenting agents: hydroquinone, often in triple combination with a retinoid and a mild corticosteroid for limited periods; alternatives include azelaic acid, kojic acid, niacinamide and topical tranexamic acid. Oral tranexamic acid may be used in resistant cases after screening for clotting risk.
Procedure: Superficial chemical peels or carefully selected low-energy lasers as adjuncts; aggressive procedures can worsen pigmentation in darker skin.
Conservative: Review hormonal contraception and photosensitising products; pregnancy-related melasma often fades after delivery, so active treatment is usually delayed.

Complications

Frequent relapse, especially after sun exposure
Irritant dermatitis and post-inflammatory hyperpigmentation from treatments
Exogenous ochronosis (blue-black darkening) with prolonged hydroquinone use
Psychosocial impact

Prognosis

Chronic and relapsing. Epidermal melasma responds best; dermal and mixed forms improve more slowly. Pregnancy-related melasma may fade over months after delivery, while lifelong photoprotection is needed to keep improvement.

Prevention

Consistent protection from sun and visible light from adolescence
Extra photoprotection during pregnancy or hormonal contraception, especially with a family history

Test yourself

Think of the answer, then tap the question to see it.

What is the most important measure in managing melasma?

Strict, daily photoprotection against ultraviolet and visible light (tinted broad-spectrum sunscreen).

What hormonal situations classically trigger melasma?

Pregnancy (chloasma) and combined hormonal contraceptives or hormone therapy.

Which three agents make up the classic 'triple combination' cream?

Hydroquinone, a topical retinoid and a mild topical corticosteroid.

How does Wood's lamp help in melasma?

Epidermal pigment is accentuated under the lamp, while dermal pigment is not, which helps predict response.

Which oral drug that inhibits plasmin is used for resistant melasma?

Tranexamic acid, after checking for thrombotic risk.

Add to my cards (5)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: Melasma: Overview (American Academy of Dermatology, 2026).

← All conditions

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.

Skin highlighted on the Durgical 3D model