Number 3 Pigment & Lesion Disorders

A. Acquired Pigment Disorders

Number 1 Skin Cancer & Pre-Cancer Care
Number 1 Medical Dermatology
(Chronic & Inflammatory Skin Diseases)
Number 3 Pigment & Lesion Disorders
A. Acquired Pigment Disorders

B. Birthmarks & Congenital Lesions

Number 4 Non-Cancer Growth
Number 5 Surgical Dermatology (Non-Cancer Procedures)
Number 6 Cosmetic Dermatology
Melasma PDF

• Melasma

1. What Is Melasma?

Melasma is a common acquired pigmentary disorder characterized by symmetrical brown or gray-brown patches on the face—most often affecting the cheeks, forehead, upper lip, and chin.

It is a medical skin condition, not simply a cosmetic concern, and often requires ongoing management rather than a one-time treatment.

2. Why Melasma Occurs

Melasma develops due to overproduction of melanin (skin pigment) triggered by a combination of factors, including:

  • Hormonal influences (pregnancy, oral contraceptives, hormone therapy)

  • Sun and visible light exposure

  • Genetic predisposition

  • Heat and inflammation

  • Certain medications or skincare products

Because triggers vary, treatment must be individualized.

3. Who Gets Melasma?

Melasma is more common in:

  • Women (especially during reproductive years)

  • Individuals with medium to darker skin tones

  • People with a family history of melasma

  • Patients with frequent sun exposure

Men can also develop melasma and benefit from medical evaluation.

4. How Melasma Is Diagnosed

Diagnosis is usually made through:

  • Clinical skin examination

  • Wood’s lamp evaluation (to assess pigment depth)

  • Review of medical history, hormonal factors, and sun exposure

Biopsy is rarely needed but may be considered if the diagnosis is uncertain.

5. Types of Melasma

Understanding pigment depth helps guide treatment expectations:

  • Epidermal melasma – pigment closer to the surface (often responds better to treatment)

  • Dermal melasma – deeper pigment (more challenging to treat)

  • Mixed melasma – combination of both

6. Melasma Treatment Options

There is no permanent cure, but melasma can be significantly improved and controlled with a comprehensive medical approach.

7. Medical Management May Include

  • Prescription topical pigment-regulating medications

  • Anti-inflammatory and barrier-repair therapies

  • Carefully selected oral treatments (when appropriate)

  • Strict sun and visible-light protection strategies

⚠️ Treatment requires patience and consistency. Improvement is gradual.

8. Why Sun Protection Is Essential

Sunlight and visible light are the strongest triggers for melasma recurrence.

We emphasize:

  • Daily use of broad-spectrum, tinted sunscreen
  • Protective clothing and hats

  • Avoidance of peak sun hours when possible

Without sun protection, treatments are far less effective.

9. What to Expect From Treatment

  • Gradual lightening over weeks to months
  • Maintenance therapy to prevent recurrence
  • Possible flares during hormonal changes or sun exposure

  • Ongoing follow-up for adjustments

Melasma is best managed as a chronic condition, similar to eczema or psoriasis.

10. When to See a Dermatologist

Schedule an evaluation if you notice:

  • New or worsening facial pigmentation
  • Pigmentation that does not respond to over-the-counter products
  • Dark patches that worsen with sun exposure
  • Pigment changes during pregnancy or hormonal therapy

Frequently Asked Questions

What is melasma?

Melasma is a chronic pigmentary skin condition that causes brown or gray-brown patches, most commonly on the face. It occurs when pigment-producing cells (melanocytes) become overactive.

No. Melasma is not skin cancer and does not become cancerous. However, it can be persistent and emotionally distressing, which is why medical evaluation and management are important.

Melasma develops due to a combination of factors, including:
  • Sun and visible light exposure
  • Hormonal changes (pregnancy, birth control, hormone therapy)
  • Genetic predisposition
  • Heat and inflammation
Often, more than one trigger is involved.
Melasma is more common in:
  • Women
  • Individuals with medium to darker skin tones
  • People with a family history of melasma
  • Those with frequent sun exposure
Men can also develop melasma and benefit from treatment.

In some cases, melasma may fade when triggers such as pregnancy or hormonal therapy end. However, many patients experience recurrence, and long-term management is often needed.

No. Melasma is different from sun spots (solar lentigines).

    • Melasma is hormonally and inflammation driven and tends to recur
    • Sun spots are usually caused by cumulative sun exposure and are more localized

Proper diagnosis is important because treatment strategies differ.

Melasma is usually diagnosed through a clinical skin examination. Your dermatologist may also use a Wood’s lamp to assess pigment depth. A biopsy is rarely needed.

Sunlight and visible light are the strongest triggers for melasma. Without strict sun protection, even the best treatments may fail or the pigmentation may quickly return.

Treatment plans are individualized and may include:

    • Prescription topical medications
    • Anti-inflammatory and pigment-regulating therapies
    • Oral treatments in select cases
    • Strict sun and visible-light protection

Melasma requires consistent, long-term management, not a single treatment.

Improvement is gradual and often takes several weeks to months. Maintenance therapy is usually needed to help prevent recurrence.

Yes. Melasma is a chronic condition and can recur, especially with sun exposure or hormonal changes. Ongoing maintenance and sun protection are key.

Do not stop any medication without consulting your prescribing physician. Your dermatologist can discuss how hormones may affect melasma and coordinate care if needed.

Some over-the-counter products may provide mild improvement, but medical-grade treatments are often more effective. Improper product use can worsen pigmentation.

You should seek evaluation if:

    • Facial pigmentation is new or worsening
    • Dark patches do not improve with basic skincare
    • Pigmentation worsens with sun exposure
    • Melasma affects your confidence or quality of life