What are the aims of this leaflet?
This leaflet has been written to help you understand more about melasma. It tells you what it is, what causes it, what can be done about it and where you can find out more about it.
What is melasma?
Melasma, also called ‘chloasma’ and ‘pregnancy mask’, is a common skin condition of adults in which light to dark brown or greyish patches of pigmentation develop mainly on facial skin. The name comes from melas, the Greek word for black. It is more common in women, especially pregnant women, and people with darker skin-types who live in sunny climates. However, it can also affect men (10% of patients) and any race. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection therefore it is not contagious and it is not due to an allergy. It is not cancerous and will not develop into skin cancer.
What causes melasma?
The exact cause is not known, but several factors can contribute. These include pregnancy, hormonal drugs such as the oral contraceptive pill, and medical conditions that affect hormone levels. Sunshine and the use of sun-beds can make the tendency to melasma worse.
Is melasma hereditary?
No, although Melasma can be commoner in family members.
What does melasma look like?
Melasma appears as darker-than-normal skin affecting the cheeks, forehead, upper lip, nose and chin, usually in a symmetrical manner. It may be limited to the cheeks and nose or the skin of the jaw region. The neck and the forearms can also be affected. Areas of melasma are not raised.
What are the symptoms of melasma?
The cosmetic appearance of melasma can be upsetting and affect quality of life. Affected skin is not itchy or sore.
How is melasma diagnosed?
Melasma is usually easily recognised by the characteristic pigmentation and distribution on the face. Occasionally, your dermatologist may suggest that a small sample of skin (numbed by local anaesthetic) is removed for examination under the microscope (a biopsy) in order to exclude other diagnoses.
Can melasma be cured?
No, at present there is no cure for melasma, but there are several treatment options that may improve the appearance. If melasma occurs during pregnancy, it may resolve a few months after delivery and treatment may not be necessary.
How can melasma be treated?
Melasma treatments fall into the following categories, and can be used together:
Avoiding known trigger factors, such as the oral contraceptive pill.
Adopting appropriate sun avoidance measures and using sun-blocking creams.
Chemical peels, dermabrasion and laser treatment.
Skin affected by melasma darkens more than the surrounding skin with exposure to sunlight, so sun-avoidance and sun-protection are important (see the ‘top sun safety tips’ below for more information).
Skin lightening creams
Certain chemicals can reduce the activity of pigment-forming cells in the skin, and of these, hydroquinone is the most commonly used. Hydroquinone creams may cause irritation, and care must be taken to ensure that they are not used for too long in case they cause excessive skin lightening. Hydroquinone can occasionally cause increased darkening of the skin, especially in dark-skinned people. Hydroquinone creams can now only be prescribed by doctors.
Azelaic acid and retinoid creams that are used to treat acne can also help melasma.
All these creams can irritate the skin and are therefore sometimes combined with steroid creams. Some skin bleaching creams contain a mixture of these ingredients.
Chemical Peels, Micro-Dermabrasion and Laser-treatment
Chemical peels can improve melasma by removing the outermost cells of the skin that contain the excess pigment. These techniques should be undertaken by an experienced practitioner as they have the potential to make the pigmentation worse, to lighten the skin too much or to cause scarring.
Some types of laser also remove the outer layer of skin, whereas others specifically target the pigment-producing cells. At present, the success of laser treatment is variable, and the possible side effects can be similar to peels and micro-dermabrasion as mentioned above.
These treatments are usually not available as NHS procedures.
Skin camouflage is a highly pigmented crème which is matched to individual skin colour and is relatively difficult to remove. A health care professional will be able to help you locate a local service.
Self care (What can I do?)
The most important thing you can do if you have melasma is to protect your skin from sunlight exposure. It is also important to avoid the use of sunbeds.
If melasma improves, sustained improvement can be achieved by continuing to protect your skin from the sun.
Top sun safety tips
Protect your skin with clothing, and don’t forget to wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses.
Spend time in the shade between 11am and 3pm when it’s sunny. Step out of the sun before your skin has a chance to redden or burn. Keep babies and young children out of direct sunlight.
When choosing a sunscreen look for a high protection SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA. Apply plenty of sunscreen 15 to 30 minutes before going out in the sun, and reapply every two hours and straight after swimming and towel-drying.
The British Association of Dermatologists recommends that you tell your doctor about any changes to a mole or patch of skin. If your GP is concerned about your skin, make sure you see a Consultant Dermatologist – an expert in diagnosing skin cancer. Your doctor can refer you for free through the NHS.
Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.
It may be worth taking Vitamin D supplement tablets (available widely) as strictly avoiding sunlight can reduce Vitamin D levels. You should consult your doctor about this.
Vitamin D advice
The evidence relating to the health effects of serum Vitamin D levels, sunlight exposure and Vitamin D intake remains inconclusive. Avoiding all sunlight exposure if you suffer from light sensitivity, or to reduce the risk of melanoma and other skin cancers, may be associated with Vitamin D deficiency.
Individuals avoiding all sun exposure should consider having their serum Vitamin D measured. If levels are reduced or deficient they may wish to consider taking supplementary vitamin D3, 10-25 micrograms per day, and increasing their intake of foods high in Vitamin D such as oily fish, eggs, meat, fortified margarines and cereals. Vitamin D3 supplements are widely available from health food shops.
Where can I get more information about melasma?
Web links to detailed leaflets:
Links to patient support groups:
British Association of Skin Camouflage (NHS and private practice)
Tel: 01254 703 107
Tel: 0300 012 0276 (for the Skin Camouflage Service)
Skin Camouflage Network (NHS and private practice)
Helpline: 0785 1073795
For details of source materials used please contact the Clinical Standards Unit (firstname.lastname@example.org).
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED FEBRUARY 2009
UPDATED MARCH 2012, FEBRUARY 2015
REVIEW DATE MARCH 2018