Melasma (hormonal pigmentation)

Melasma is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation in these patterns: 

  • forehead, cheeks, nose and upper lips affected 
  • cheeks and nose
  • cheek pattern
  • jawline
  • Reddened or inflamed forms of melasma 
  • reddened and sun damaged changes seen on the sides of the neck, mostly affecting patients older than 50 years (Poikiloderma of Civatte)
  • melasma affecting shoulders and upper arms

It can lead to considerable embarrassment and distress.

Melasma is more common in women than in men and generally starts between the age of 20 and 40 years, but it can begin in childhood or not until middle age.

Melasma is more common in people that tan well or have naturally brown skin compared with those who have fair skin or black skin.

The cause of melasma is complex. The pigmentation is due to overproduction of skin pigment (melanin) by the pigment cells (melanocytes). There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people melasma is a chronic disorder with no 100% cure. 

Known triggers for melasma include:

  • Sun exposure and sun damage—this is the most important avoidable risk factor
  • Pregnancy—in affected women, the pigment often fades a few months after delivery
  • Hormone treatments—oral contraceptive pills containing oestrogen and/or progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women
  • Certain medications, scented or deodorant soaps, toiletries and cosmetics—these may cause a reaction that triggers melasma, which may then persist long term
  • Hypothyroidism (low levels of circulating thyroid hormone)

Treatment Strategies

1. Strict sun protection of the affects areas: daily broad spectrum sunscreen reapplied every 2 hours, dark coloured broad brimmed hat, thick opaque zinc based sunscreen if near reflected light (water, sand)

2. Consider stopping or changing hormonal medication (contraceptives) 

3. Chemical Exfoliation with prescription vitamin A and acid based skin care (lowering the skin's pH helps prevent more pigmentation)

4. Prescription fading creams

5. Chemical peels (see our section on chemical peels)

6. Laser (very specific lasers and doctors required for this)

Results take time and the above measures are rarely completely successful.

Unfortunately, even in those that get a good result from treatment, pigmentation may reappear on exposure to summer sun and/or because of hormonal factors.