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Melasma

Definition

Melasma is a dark skin discoloration that appears on sun-exposed areas of the face.

Alternative Names

Chloasma; Mask of pregnancy; Pregnancy mask

Causes, incidence, and risk factors

Melasma is a very common skin disorder. Though it can affect anyone, young women with brownish skin tones are at greatest risk.

Melasma is often associated with the female hormones estrogen and progesterone. It is especially common in pregnant women, women who are taking birth control pills (oral contraceptives) and women taking hormone replacement therapy (HRT) during menopause.

Sun exposure is also a strong risk factor for melasma. The condition is particularly common in tropical climates.

Symptoms

Melasma doesn't cause any other symptoms besides skin discoloration but may be of great cosmetic concern.

A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face).

Signs and tests

Your health care provider can usually diagnose melasma based upon the appearance of your skin. A closer examination using a Wood's lamp may help guide your treatment.

Treatment

Treatments may include:

• Creams containing a combination of tretinoin, kojic acid, and azelaic acid have been shown to improve the appearance of melasma.
• Your doctor may recommend chemical peels or topical steroid creams.
• In severe cases, laser treatments can be used to remove the dark pigment.

Avoiding the sun and using sunscreen are key to preventing melasma.

Support Groups

Expectations (prognosis)

Melasma often fades over several months after stopping birth control pills or HRT, or after delivering a child. It may return with additional pregnancies or use of these medications.

Complications

Calling your health care provider

Call your health care provider if you have persistent darkening of your face.

Prevention

Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles.

References

Habif TP. Light-related diseases and disorders of pigmentation. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 19.

Sood A, Tomecki KJ. Pigmentary disorders. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010.