Melasma is a skin condition that affects far more people than most realise, and it is often mistaken for sun damage or ageing. The patches it causes can look similar to other forms of pigmentation, but melasma has its own distinct causes and triggers. It can affect anyone, though it is particularly common in women and in people with darker skin tones, and it often appears or worsens during pregnancy, which is why it has earned the nickname the pregnancy mask.
This guide explains what melasma is, why it happens, what the symptoms look like, and how to treat it, including the treatment options available for you.
Melasma is a common skin condition that causes flat patches of brown, grey or tan pigmentation to develop on the skin, most often on the face. It typically appears on the cheeks, forehead, nose, chin and upper lip, usually in a symmetrical pattern on both sides of the face.
Melasma is also known as chloasma, and when it occurs during pregnancy it is sometimes called the pregnancy mask. It is far more common in women than men and tends to develop between the ages of 20 and 40, although it can affect anyone.
It is important to know that melasma is not harmful, painful or contagious. It will not turn into skin cancer, and it is not a sign of any underlying disease in the vast majority of cases. Understanding what causes it is the first step towards finding a treatment plan that actually works for your skin.
The exact cause of melasma is not fully understood, but doctors know it develops when pigment producing cells in the skin, called melanocytes, become overactive and produce too much melanin. Several factors are known to trigger or worsen this process.
Sun exposure. Ultraviolet light from the sun is one of the biggest triggers for melasma. Even brief, regular sun exposure can stimulate pigment production and make existing melasma darker. Visible light, including the light from windows and some screens, may also play a role.
Hormonal changes. Melasma is strongly linked to hormonal fluctuations, which is why it is so common during pregnancy and is sometimes triggered by the contraceptive pill or hormone replacement therapy. Hormonal conditions, such as thyroid disorders, can also be a factor.
Genetics. Family history appears to play a part. Studies suggest that more than half of people with melasma have a relative who has also experienced it.
Skin tone. Melasma is more common in people with darker skin tones and those who tan easily, although it can affect anyone.
Certain medications. Some medications, including those used to treat epilepsy, have been associated with melasma in rare cases.
Melasma usually presents with the following features.
Melasma is usually diagnosed by a dermatology doctor through a simple visual examination. In most cases, the pattern, colour and location of the pigmentation are enough to confirm a diagnosis, as melasma has a fairly distinctive symmetrical appearance.
In rare cases, if there is any doubt about whether the pigmentation is caused by melasma or another condition, a dermatology doctor may take a small skin sample, known as a biopsy, for further examination. This is not common and is usually only considered when the diagnosis is unclear.
While melasma cannot always be cured completely, there are several effective ways to manage and significantly improve its appearance. The best approach is usually a combination of daily sun protection alongside one or more clinical treatments.
Sun Protection
This is the single most important step in treating melasma, and it underpins every other treatment. Without strict daily sun protection, melasma will keep returning no matter what other treatments are used. Doctors recommend a broad-spectrum sunscreen of at least SPF30, applied every morning and reapplied throughout the day, along with wearing a wide brimmed hat when outdoors. It is worth knowing that standard sunscreen does not fully protect against visible light, including light from screens and overcast skies, which can also trigger melasma. For this reason, doctors increasingly recommend a tinted sunscreen containing iron oxide, as this adds protection against visible light on top of the usual protection from UVA and UVB rays.
Topical Creams
Several prescription and over the counter creams can help fade melasma over time. These include ingredients such as hydroquinone, azelaic acid, vitamin C and tranexamic acid, which work by reducing melanin production. These creams must be used under medical guidance, as some are not suitable for long term use or during pregnancy.
Oral Tranexamic Acid
For melasma that does not respond well enough to creams alone, your doctors may consider prescribing oral tranexamic acid. It works by reducing the activity in the skin that drives pigment production, and several studies have shown it can lead to a noticeable improvement after a few months of use. It is only available on prescription and is not suitable for everyone, including those with a history of blood clots or those who are pregnant, so it should only be taken under medical supervision.
Chemical Peels
Chemical peels work by gently removing the outer layers of pigmented skin, encouraging fresh, more evenly toned skin to come through. Peels such as Cosmelan or Dermamelan are specifically designed to target melasma and stubborn pigmentation, and many patients see a noticeable improvement after a course of treatment. Your doctor would advise on which treatment might be best suited for you, as the right peel depends on your skin type and the depth of pigmentation.
Laser and Light-Based Treatments
Certain lasers can target pigment producing cells directly. These treatments can be effective but carry a risk of making melasma worse if not performed correctly, so they should only be carried out by an experienced practitioner who understands how melasma behaves differently to other types of pigmentation.
Microneedling
This treatment uses fine needles to create controlled micro-injuries in the skin, which can help active ingredients penetrate more effectively and support overall skin renewal.
It is worth noting that combining treatments often produces the best results. Many patients find that a tailored plan, built around their specific skin type and pigmentation depth, works far better than relying on a single product or procedure.
Melasma can be frustrating to manage on your own, particularly when over the counter products have not made a noticeable difference. At The Blackwell Clinic, our doctors offer a thorough assessment to confirm a melasma diagnosis and rule out other causes of skin discolouration. From there, we build a treatment plan suited to your skin, which may include prescription creams, oral tranexamic acid, peels such as Cosmelan or Dermamelan, or a combination of approaches.
Book a consultation with us at The Blackwell Clinic to find out what is really going on with your skin and what treatment options are available to you.
Frequently Asked Questions
Melasma can fade over time, particularly if it was triggered by pregnancy or a temporary hormonal change, and it often improves a few months after delivery. However, for many people melasma does not disappear on its own and requires ongoing management. With consistent sun protection and the right treatment plan, melasma can be significantly improved, although it may return if triggers such as sun exposure or hormonal changes occur again.
Dark spots can be caused by several things, including melasma, sun damage, ageing, hormonal changes, and inflammation following acne or skin injury. A doctor can usually identify the specific cause through examination, which helps determine the most effective treatment.
Melasma is not necessarily permanent, but it can be persistent and tends to return if sun protection is not maintained. Some people see significant fading with treatment, while others require ongoing management to keep pigmentation under control.
Yes, although melasma is far more common in women, men can develop it too, particularly those with darker skin tones or higher sun exposure.
No. Sunspots, also called age spots, are caused purely by cumulative sun exposure and tend to be smaller and more clearly defined. Melasma is linked to hormonal changes as well as sun exposure and typically appears as larger, more symmetrical patches.
This varies depending on the treatment and the depth of pigmentation, but most people begin to notice an improvement within several weeks of starting treatment, with fuller results typically seen over a few months of consistent use and ongoing sun protection.
Yes, melasma can return, particularly if sun protection is not maintained or if hormonal triggers, such as pregnancy or contraceptive use, occur again. This is why ongoing sun protection is so important even after successful treatment.
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