What is melasma?

Melasma is a common skin condition that causes brown or grayish-brown patches to appear on the face, typically in areas that are more exposed to the sun, such as the cheeks, forehead, nose, and chin. It is most often seen in women, especially during pregnancy, but can also affect men. The condition is thought to be triggered by factors like sun exposure, hormonal changes, and genetics. While melasma itself is not harmful, it can cause cosmetic concern for those affected.

Which part does melasma generally affect?

Melasma most commonly affects sun-exposed areas of the face, typically causing these areas to develop dark, irregular patches of pigmentation. In some cases, melasma can also appear on other areas of the body, such as the neck and arms, although this is less common.

Most commonly affected areas of the face and body are-

• Cheeks: The sides of the face are often the first areas to develop dark patches.
• Forehead: The area above the eyebrows and across the forehead is frequently involved.
• Nose: The bridge of the nose can show dark patches as well.
• Upper lip: The area above the upper lip, often resembling a “mustache,” is a common spot for melasma.
• Chin: The chin area may also be affected, sometimes leading to more widespread facial involvement.
• Neck: Melasma can extend to the sides or back of the neck in some cases.
• Arms: The forearms, particularly in areas exposed to sunlight, may also show signs of melasma.
• Chest: The décolletage or chest area can develop pigmentation in some individuals, especially in those with a lot of sun exposure.

What is the incidence of this condition?

The incidence of melasma varies depending on factors such as gender, age, and geographic location. However, some general statistics about its occurrence include:

Gender: Melasma is far more common in women than men. This is largely due to hormonal influences, such as those associated with pregnancy, oral contraceptives, and hormone replacement therapy.

Age: Melasma typically develops in individuals between the ages of 20 and 40, with most cases appearing during a woman’s reproductive years. It is less common in children and older adults.

Geographic location: Melasma is more prevalent in areas with high sun exposure, especially in people with darker skin types (Fitzpatrick skin types III to VI).

Estimated prevalence: It’s estimated that melasma affects about 1-2% of the general population. However, its prevalence can be much higher in populations with more sun exposure and those with darker skin.

What is the main cause of melasma?

 The exact cause of melasma is not entirely understood, but following factors contribute to    its development:

Sun exposure: Ultraviolet light from the sun triggers melanocytes to produce more pigment, leading to darker skin patches.

Hormonal changes: Pregnancy (often referred to as the “mask of pregnancy”), birth control pills, hormone replacement therapy, or other hormonal treatments can trigger melasma.

Genetic predisposition: A family history of melasma can increase the likelihood of developing the condition.

Medications: Certain medications, such as oral contraceptives or hormone therapy, may increase the risk of melasma, especially in people who are predisposed to it.

Skin type: Individuals with darker skin types (e.g., Fitzpatrick skin types IV-VI) are more prone to melasma, as they have more active melanocytes.

Other possible causes are:

• Contraceptive therapy
• Hypothyroidism
• LED screens
• Makeup
• Phototoxic drugs
• Soaps

Is melasma a permanent condition?

Melasma is not a permanent condition, but it can be persistent and challenging to treat. In many cases, it can improve or even resolve over time, specially if the triggering factors like hormonal changes or sun exposure are effectively managed. Although, melasma can also recur, if proper sun protection and skincare practices are not maintained.

What are the different types of melasma?

Melasma is categorized into different types based on the depth of the pigmentation and where the discoloration appears in the skin. The three main types are epidermal, dermal, and mixed melasma.

1.Epidermal melasma- This type of melasma affects the outer layer of the skin where the pigmentation is usually more superficial and the dark patches are typically brown or dark brown in color. They tend to have well-defined edges and can be lighter or darker in different areas. These spots appear more obvious on wooden lamp.

2.Dermal melasma- It affects the deeper layers of the skin, specifically the dermis. The discoloration in this type of melasma tends to appear bluish or grayish-brown and may have ill-defined edges. These spots show no attenuation on wooden lamp.

3.Mixed melasma- It is a combination of both epidermal and dermal melasma, meaning that the pigmentation affects both the outer and deeper layers of the skin. It may present as a mix of brown and grayish tones, and the patches might have both well-defined and irregular edges. Mixed pattern of spots is seen with wooden lamp.

Why is melasma more commonly seen during pregnancy?

Melasma is more common during pregnancy due to hormonal changes that occur in a woman’s body. These hormonal fluctuations stimulate the production of melanin, the pigment responsible for skin color, leading to the characteristic dark patches of melasma. When melasma occur during pregnancy it is called “chloasma”.

The following factors may contribute to why melasma is more prevalent during pregnancy-

1. Rise in hormones like estrogen and progesterone during pregnancy may lead to over stimulation of melanocytes hence leading to hyperpigmentation of skin.
2. Increased sensitivity to UV lights during pregnancy.
3. Genetic predisposition which could be triggered by hormonal fluctuations.
4. During pregnancy, there is an increase in blood flow to the skin, particularly on the face, which can cause the skin to become more reactive.

Can hormonal imbalance cause melasma?

Yes, melasma is a hyper pigmentation of the skin and is associated with the hormonal imbalance especially with pregnancy, thyroid problem, birth control pills, etc. therefore hormones are responsible for melanocyte stimulating hormones (MSH).

What are the symptoms for melasma?

The primary symptom of melasma is the appearance of dark, pigmented patches on the skin, usually on the face. These patches are typically asymptomatic but may also present as the following symptoms-

1. Dark, irregular patches- This dark patches are typically brown or grayish-brown in color and can appear as irregularly shaped or more uniform patches, which may vary in size.
2. Symmetry–The dark patches of melasma are often symmetrical, meaning they appear on both sides of the face or other affected areas.
3. Skin change- Melasma does not typically cause any itching, burning, or other forms of skin irritation. The skin in the affected areas remains intact and does not feel different from the surrounding skin.
4. Gradual onset-Melasma usually develops gradually, and the patches may become more noticeable over time, especially if they are exacerbated by sun exposure or hormonal changes.
5. Variations in pigmentation-In some cases, melasma may have darker and lighter areas within the same patch, giving it a mottled or uneven appearance.

Is melasma curable?

There is no certain cure for this skin condition but there are several treatments which improves the appearance. If the disease occurs during pregnancy, it may resolve on its own after few months of delivery. Although superficial pigmentation is easier to treat than deep pigmentation.

Can melasma turn into cancer?

Melasma is a benign (non-cancerous) condition that involves an increase in melanin production, leading to dark, pigmented patches on the skin. It is primarily caused by hormonal changes, sun exposure, and genetic factors, but it is not linked to skin cancer.

Does prolonged stress trigger melasma?

Yes, this skin disease can be triggered by stress because stress results in the overproduction of melanocyte stimulating hormone and causes freckles / melasma though it is not considered a direct trigger for melasma in the same way as sun exposure or hormonal changes are.

How can I reduce brown spots from my face?

Apply lemon juice and sugar on the pigmented area of the face and leave this paste for half an hour and after 30 minutes wash your face with water. This is one of the natural way to lightened the hyper pigmentation.

Can certain foods affect melasma?

Yes, certain foods can influence melasma, although diet alone is not typically a primary factor in its development or treatment.

Foods that may worsen melasma are-

1.Spicy foods

2.Alcohol

3.Excessive fats

4.Sweets

Foods that may help manage melasma are-

1. Foods high in vitamin C
2. Diet rich in Vitamin D such as:

• Almond milk
• Eggs
• Meat 
• Milk
• Mushroom
• Oily fish
• Orange juice
• Yogurt

3. Omega-3 fatty acids: Foods like salmon, walnuts, and flaxseeds
4. Proper hydration

How long does it take for hyper pigmentation to fade?

Generally it can take 3 – 24 months to fade but in some cases it may take longer time. It depends on how dark the spots or pigmentation is, as compared to the surrounding skin.

Can my skin condition of  melasma be related to thyroid disorder?

Melasma and thyroid conditions are linked in some cases, though they are distinct health issues. The connection between them primarily stems from hormonal imbalances, as both melasma and thyroid disorders are influenced by hormones in the body.

Although the key link between melasma and thyroid disorders is the role of hormones. Melasma is often triggered or worsened by hormonal fluctuations, particularly those related to estrogen and progesterone, which are present in high levels during pregnancy, birth control use, or hormone replacement therapy. Similarly, thyroid imbalances can disrupt the body’s overall hormonal balance, indirectly influencing conditions like melasma.

What other diseases can look like melasma?

Some of the common differential diagnoses for melasma are-

1. Lentigines- these are also known as age spots or sun spots which are flat, brown spots that typically appear on sun-exposed areas, especially as people age. They are often isolated and well-demarcated unlike melasma, which tends to be symmetrical and more diffuse.
2. Post inflammatory hyperpigmentation- PIH typically follows a skin injury (e.g., acne lesions or cuts), whereas melasma is usually associated with hormonal changes or sun exposure without previous injury to the skin.
3. Acanthosis nigricans- Acanthosis nigricans commonly associated with insulin resistance and obesity often represents itself with a velvety texture and typically appears in flexural areas, unlike melasma, which predominantly affects sun-exposed areas of the face.
4. Melanoma- It is a malignant form of skin cancer that can present as an irregularly shaped or multicolored mole or dark patch. It often has uneven borders, color variation, and can change in size or shape whereas melasma is usually symmetrical, with uniform pigmentation and shows no changes over time.
5. Scleroderma- It is a condition that leads to skin thickening and hardening, which may result in pigmentation changes while melasma does not alter skin texture and is limited to pigmentation.
6. Tinea faciei- A fungal infection that can cause red, scaly, ring-shaped lesions on the face which often presents as irregular, circular patches unlike melasma, which presents as brown patches without scaling, tinea faciei will typically have scales and itching.

What homeopathic medicines can be prescribed in case of hyperpigmentation?

Homeopathy offers the safest and highly effective natural treatment for cases of facial hyperpigmentation. Homeopathic medicines helps to prevent further spread of hyperpigmentation after which it gradually helps in lightening and fading away of the spots of the face. These medicines control excessive melanin production to reduce production and promote recovery. 

Here are some commonly used homeopathic remedies that may help with melasma:

1. Sepia: It is a top grade homeopathic medicine for facial hyper pigmentation. Hyper pigmentation appears on cheeks and forehead which worsens during pregnancy and menopause mostly due to hormonal imbalance.  Pigmentation varies from brownish to blackish in color. The skin may be rough and hard. This remedy is said to help with the overall improvement of skin tone, restoring balance to the complexion and reducing the appearance of dark patches, especially when these patches are related to hormonal changes or stress.
2. Thuja occidentalis:  Best suited for facial pigmentation and freckles. It works wonderfully in case of hyperpigmentation due to hormonal imbalance especially after hormonal treatment or contraceptive use. It is indicated for both freckles and blotches. The skin looks dirty and dry, and uneven brown spots. Skin is very sensitive to touch. Brown spots on hands and arms. It is known in the management of pigmentation which is due to sun exposure. Thuja is also used when there is an increase in skin sensitivity, dryness, or irritation.
3. Lachesis mutus- It is used in treating pigmentation in women of menopausal age. The pigmentation ranges from bluish-purplish to bluish-black. Woman usually complain of hot perspiration along with other menopausal symptoms such as hot flushes relieved by perspiration or occurrence of menses. Symptoms ameliorates during winters and reappear during spring season. Lachesis can address the emotional imbalance that might contribute to the skin condition. It is also beneficial if melasma is accompanied by other signs of poor circulation, such as varicose veins or a tendency to bruise easily.
4. Cadmium sulph- This medicine is used in case of hyperpigmentation which varies from yellowish to brownish in color. The pigmentation occurs in brown spots over the entire face, mainly around nose and cheeks. This remedy helps in reducing the intensity of pigmentation and may lead to a more even skin complexion. The hyperpigmentation gets worse by the sun exposure and wind. The skin is yellow, scaly, cracking with itching which is better by scratching. 
5. Pulsatilla- It is often prescribed for people who are emotionally sensitive, weepy, or moody. Pulsatilla is often indicated for individuals who have sensitive skin, particularly when their skin is prone to dark spots or pigmentation changes. Also suitable in cases of facial hyper pigmentation present along with menstrual irregularities Face is sickly, often mottled, face often flushes with dark rings around the eyes. Menses are delayed , scanty and suppressed menses. Hyper pigmentation can be present along with acne.

Disclaimer: The information provided is for educational purposes only and should not be construed as medical advice. Always consult a qualified healthcare professional or physician before starting any treatment or using any medication. Self-medication without professional guidance can be harmful to your health. The content provided here is not intended to replace professional medical advice, diagnosis, or treatment.