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That Patchy Skin Problem: Treating Melasma

Mar 01, 2017 02:00PM ● By Becca Newell
By Becca Newell

Is patchy skin making you look older? You’re not alone. Between four to five million people in the United States suffer from a common hyperpigmentation disorder called Melasma, which causes brown or brown-grey patches—similar to sunspots—to develop on one’s face and/or forearms.

Also referred to as Cholasma, there are no other symptoms of Melasma other than skin discoloration, mainly on one’s cheeks, forehead, nose, chin, and upper lip. And while Melasma affects both sexes, it’s more common in women.

“Approximately 90 percent of cases are women,” says Physician/Dermatologist Thomas Meskey, M.D., of Annapolis Dermatology Associates. “More frequently among people of Asian or Hispanic descent.”

The disorder is primarily caused by ultraviolet (UV) light, according to Meskey, who recommends diligent sun protection to help prevent development.

“Sunscreen, hats, and sun avoidance,” he adds.

In addition to sun exposure, Melasma is associated with estrogen and progesterone, according to President/Founder Lisa Kates, M.D., of Center for Dermatology and Skin Care of Maryland.

“It is common in pregnant women, women taking oral contraceptives, and women taking hormone replacement therapy during menopause,” she says, adding that Melasma is often called “Mask of Pregnancy.”


Approximately 90% of [melasma] cases are women. More frequently among people of Asian or Hispanic descent.”

—Physician/Dermatologist Thomas Meskey, M.D., of Annapolis Dermatology Associates

For women who fall into any of the categories listed above, sun protection is even more important because they are highly susceptible to developing the disorder. However, if Melasma develops during pregnancy or while a patient is taking hormone medication, hyperpigmentation is likely to fade once the pregnancy ends or treatment discontinues.

“The problem may come back in future pregnancies or if you use these medicines again,” says Kates.

The good news? Melasma is treatable—“to some degree,” adds Meskey—through a variety of creams, chemical peels, or, in severe cases, laser resurfacing. For most patients, treatment begins with a topical solution, usually a combination of tretinoin, hydroquione, kojic acid, and azelaic acid, according to Kates.

Though topical treatments are often successful, symptoms won’t disappear overnight. Daily application of the prescribed cream is imperative, along with the use of sunscreen—or a tinted moisturizer or foundation with SPF.

“I encourage a trial of at least six months before discontinuing therapy if no improvement is seen,” Meskey says.

Though deeper chemical peels, dermabrasion, and laser treatments have been successful in reducing hyperpigmentation in patients that didn’t respond well to topical solutions, Meskey is keen to note that caution is warranted.

“These more abrasive treatments may occasionally exacerbate pigment abnormalities and/or result in scarring,” he says.

Still, the best line of defense against Melasma—and during treatment for the condition—is sun protection.

“Use high SPF sunscreen religiously,” says Kates.


Tretinoin: A retinoid related to vitamin A, Tretinoin works by “lightening the skin, replacing older skin with newer skin, and by slowing down the way the body removes skin cells that may have been harmed by the sun,” according to the Mayo Clinic. Hydroquione: A skin-bleaching agent used to lighten skin discoloration. Kojic Acid: Developed as a replacement to hydroquinone, kojic acid was reported by the Mayo Clinic in 2009, as an effective skin lightening treatment if applied for a long period of time (several weeks to a few months). Azelaic Acid: Primarily used to treat acne and rosacea, azelaic acid has been used “off-label” to treat Melasma.

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