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A close up of a woman with freckles on her face.

What is Melasma?  

Melasma is a chronic skin condition that causes dark, gray-brown patches to appear on the skin. It’s commonly associated with sun damage as too much sunlight exposure can cause the skin to produce more pigment and darken the facial skin. 

Some cases of melasma can be mistaken for freckles as it can also form small spots on the skin. However, melasma patches are typically larger than the usual sun spots, freckles, and age spots. 

Women are more likely to develop patches of skin discoloration than men. Melasma is also thought to be linked to hormonal changes and can often occur in pregnant women. This skin condition is sometimes called ‘the mask of pregnancy’.  

What Causes Melasma? 

Melasma is related to the melanocytes or the pigment-producing cells in the skin. Melanocytes are found in the basal cell layer at the epidermis and they are mainly responsible for creating melanin that gives the skin its color. 

It’s highly likely that dark patches of melasma appear when the melanocytes are stimulated and produce too much pigment. There are several factors that can contribute to the overproduction of these skin cells like 

  • Sun exposure - The ultraviolet light from the sun can cause the skin to produce more melanocytes and worsen the existing symptoms of melasma. 
  • Hormone changes - Pregnancy can cause hormone fluctuations and the increased levels of estrogen and progesterone can influence melanin production. Additionally, taking birth control pills and hormone replacement therapy can lead to melasma. 
  • Use of certain skincare products - Some cosmetic or skincare products can irritate your skin and cause discoloration or phototoxic reaction (similar to a sunburn or rash).  
  • Tanning beds - The UV light from tanning beds can be just as damaging to your skin as frequent sun exposure. 
  • LED Light - Blue lights from bulbs, computer screens, television, and other electronic devices can likewise cause melasma.
  • Scented soaps and fragrances - The use of deodorant soaps, scented fragrances, and other cosmetics may also trigger melasma symptoms.  
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At Dermatology & Skin Health, we offer world-class services done by award-winning doctors who have proven their knowledge and skills in this field. Start your journey towards achieving your best skin by contacting us today.

Risk Factors for Melasma  

The risk of having melasma is higher in individuals of a particular race or skin tone and type. Generally, people with medium or darker skin tones are more prone to this condition because they have more active melanocytes than people with lighter skin. It also commonly affects women who are of Latin, Hispanic, Asian, Black, or Native American descent. 

Women who are in their second or third trimester of pregnancy are also at an increased risk for melasma. Genetics may also play a role in the development of melasma. If you have a family member that has melasma, it’s highly likely that you will also develop discolored patches at some point in life. 

Melasma may also be triggered by certain autoimmune conditions such as adrenal dysfunction or thyroid disease. Chronic stress can also be a factor in the appearance of melasma patches. When your body is under stress or pressure, you release certain hormones that can affect estrogen levels. 

Signs and Symptoms of Melasma

The first signs of facial pigmentation of melasma are tan, gray-brown, dark, and sometimes bluish patches on the skin. The color of pigmentation can vary depending on the person’s skin tone and the severity of the condition. But generally, melasma patches should appear darker than your natural color. 

Some cases of melasma can look like spots that resemble the appearance of freckles. It is a totally harmless skin disorder with no other symptoms of itching or pain. It is mostly a cosmetic issue that can affect your overall self-confidence in your appearance. 

Where Does Melasma Commonly Appear?  

Melasma can often develop on the face, especially the cheeks, chin, above the upper lip, nose, and forehead. It can also form on other areas that get sun exposure such as the jawline, neck, chest, back, and forearms. To be specific, a dermatologist may diagnose melasma in six common locations: 

  • Brachial - This is when the patches appear on the shoulders and upper arms.  
  • Centrofacial - This is when the melasma affects most of the facial skin, including the forehead, nose, and upper lip.
  • Lateral cheek pattern - This refers to pigmentation that appears on both sides of the cheeks. 
  • Malar - This refers to melasma that appears on both cheeks and the nose. 
  • Mandibular - This refers to the darker patches that are noticeable along the jawline. 
  • Neck - Melasma patches on the neck are more common among people who are aged 50 and older. 
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Different Types of Melasma  

Melasma can be categorized into three main types depending on the depth of the pigmentation. During a skin consultation with a dermatologist, they can determine the type of melasma that you have with the help of a Wood’s lamp. Here are the three common classifications of melasma: 

Epidermal Melasma 

This form of melasma commonly appears on the superficial layers of the skin.  It usually develops a dark brown patch with a noticeably defined border. Under Wood’s lamp examination, epidermal melasma can be instantly visible on the skin. Since this is somewhat a milder form of melasma, it can clear up with proper treatment. 

Dermal Melasma 

Unlike epidermal melasma that forms on the top layer of the skin, this type of hyperpigmentation occurs due to the increase of pigment in the deeper layers of the dermis. They usually have a light brown or bluish color with a slightly blurred border. They will look the same under the black light and they may not be easily eliminated with treatment. 

Mixed Melasma

As its name suggests, mixed melasma is a combination of dermal and epidermal hyperpigmentation. Its patches can appear brown to bluish on the skin. It will show a mixed pattern under Wood’s lamp and it can be improved with treatment. 

Is Melasma Cancerous? 

Melasma isn’t a life-threatening condition and it’s not a sign of skin cancer. It’s also very unlikely that hyperpigmentation will turn cancerous. However, it is advised to immediately visit your healthcare provider if you notice unusual pigmentation since there are cancers that may have signs similar to melasma. It’s important to get a definitive diagnosis to put your mind at ease and get proper melasma treatment. 

How to Tell If The Discolored Patches on the Skin are Cancer or Melasma

Discolored skin patches can be a sign of many skin conditions, including infections, pigmentation problems, or skin cancer. In some patients, discolored patches and spots can appear as a symptom of certain skin cancers such as basal cell carcinoma, squamous cell carcinoma, melanoma, and actinic keratosis. 

Here’s an overview of the distinct differences between the patches of melasma and skin cancer: 

Melasma Skin Cancer 
In melasma, hyperpigmentation of the skin is caused by the excess production of melanocytes and it is usually harmless. Most skin cancers are a result of damage to the healthy cells which makes them malignant and cancerous. 
The discolored patches of melasma typically appear flat and they appear darker than the surrounding skin. Patches can vary in color depending on the type of cancer that you have. For example, basal cell and squamous cell carcinoma can develop skin-colored, pink, or reddish patches and bumps. Meanwhile, melanoma can appear as new moles or dark spots on the skin. 
Aside from its unsightly appearance, you won’t feel anything with melasma patches. They do not feel itchy or painful. The patches can sometimes feel itchy and develop into open sores and blisters. 

How to Diagnose Melasma  

It’s easy for dermatologists to diagnose melasma with a simple visual examination of the existing pigmentation on your skin. They may also use the Wood’s lamp to analyze the changes in the color of your skin and identify which type of melasma you have. 

It can also reveal the extent of damage from sun exposure on the skin and determine the depth of pigmentation that’s not visible to the naked. This diagnosing technique can also help check if you have a bacterial or fungal infection that’s causing the pigmentation.  

In more severe cases, a small sample of your skin may be removed for a biopsy. This test can help rule out other skin conditions that can also cause pigmentation issues. If you have thyroid problems, you may get it checked by your healthcare provider and see if it is affecting your melasma. 

Best Treatment Options for Melasma  

There’s no definite cure for melasma but there are treatments that can help lighten the patches and improve your skin appearance. Here are some of the treatments that reduce skin discoloration: 

PicoWay Laser Treatment 

At Dermatology and Skin Health, we can remedy your melasma with non-invasive laser therapy. The PicoWay system is a popular laser melasma treatment that can safely and painlessly get rid of the patches and other pigmented lesions with very minimal discomfort and downtime. This treatment sends short pulses of laser energy to break down the melanin pigment and restore the health and natural complexion of your skin. 

Chemical Peel

This popular cosmetic treatment can help remove the dead skin cells and take away the excess pigment for improved skin tone and texture. Chemical peels can help refresh your skin with healthier and new skin cells with lesser melanin. A light chemical peel can be effective for epidermal melasma, while medium-strength peels can help pigmentation in the dermal layers. 

Topical Medications 

Topical medications like hydroquinone and hydrocortisone can also help fade the discoloration caused by melasma. They can also improve the uneven skin tone and restore a brighter complexion. 

Schedule Your Consultation Now at Dermatology & Skin Health

At Dermatology & Skin Health, we offer world-class services done by award-winning doctors who have proven their knowledge and skills in this field. Start your journey towards achieving your best skin by contacting us today.

Tretinoins and Retinols

These are prescription topical medications that are commonly used for sun damage, wrinkle, and acne treatment. They can be applied to the skin to boost the turnover of new cells and lighten the skin. 

Kojic Acid 

A doctor may also prescribe a 1% concentration of kojic acid to help clear the patches and improve the visible signs of sun damage, spots, and other lesions. It also has some anti-aging effects and can be used to brighten your skin. 

Tranexamic Acid  

This medication can come in topical or oral form, and it is usually recommended when other treatments don’t seem to work. Oral tranexamic acid can be taken twice a day to help improve melasma. 

What’s the Outlook for Melasma Treatments? 

Melasma is a chronic condition so the patches can come and go, even after receiving treatment. Fortunately, most cases of melasma can respond to the medications and cosmetic procedures and they can fade away within months to a year after starting the treatment. Some patches can also go away on their own without treatment. 

How to Take Care of Your Skin to Prevent Melasma  

The best way to avoid skin damage and pigmentation is by having ample sun protection. When going out, make sure to wear sunscreen with an SPF of 30 or above and reapply them every 2 hours. You should also limit your trips to tanning salons and avoid too much exposure to UV light or radiation. 

You should also change your skincare products and use gentler, fragrance-free cleansers and moisturizers. Avoid any cosmetic product that has an ingredient that may irritate your skin and worsen your melasma. 

See Our Melasma Specialist Today and Improve Your Skin Appearance 

If melasma is making you feel self-conscious, you can trust our team at Dermatology and Skin Health to help improve your condition and restore your confidence in your appearance. Our board-certified dermatologists can provide accurate diagnoses and recommend the right treatment plan for your pigmentation issues.

Schedule your first appointment at any of our clinics in Dover, Newington, Londonderry, Peabody, and Bedford. You can book your consultation online or give us a call at  (603) 742-5556 (Dover & Newington), (978) 525-0100 (Peabody), (603) 965-3551 (Londonderry), (603) 742-5556 (Bedford).