Unmasking Melasma – What You Need to Know

Jeanne Ellern, PA-C

There are moments throughout our lives when we all might experience changes in our skin that can be disconcerting. Most of us have had or may still have experiences with acne, age spots, scarring, and perhaps hyperpigmentation. Along the lines of hyperpigmentation, a large group of people suffers from a common acquired skin condition called melasma which causes brown or blue/gray patches to appear on the skin. It is sometimes called the “mask of pregnancy,” but can appear at any time in our lives.

Melasma Explained

Melasma is a skin condition that causes brown patches with irregular borders to appear on the face (forehead, chin, cheeks, and upper lip), but they can also appear on the chest or arms. It occurs more often in women than men, and people with darker skin tones tend to be affected more than others. The exact cause of melasma is still unknown, though it seems that certain triggers cause an overproduction of melanin (the pigment in our skin), creating these dark spots.

This skin condition can sometimes be transient, such as in pregnant women. They will experience skin changes while pregnant, with the symptoms disappearing once they have a baby. Others deal with melasma for years or even the rest of their lives.

What can trigger melasma? The list includes the following:

  • Sun exposure
  • Pregnancy
  • Birth control or hormone treatments
  • Certain skin care products
  • Some medications, including anti-seizure medication and phototoxic medications
  • Tanning beds

Genetics may also play a role, as people with a family history of melasma have a higher risk of getting it.

A Board-Certified Dermatologist or Advanced Practitioner will be able to diagnose your skin condition through a visual skin examination. While melasma does not cause other physical symptoms, it can sometimes look like other skin conditions. It is best to get a diagnosis from a specialist so that together you can choose a treatment that is the most effective for you.

Are there treatments? 

Fortunately, we have some excellent options for treating melasma. For starters, daily sun protection is a must! Use sunscreen with both UVB/UVA protection, a wide-brimmed hat, sun-protective clothing, and stay in the shade whenever possible.

There are multiple topical treatments available. Treatments depend on various factors, including the extent of the pigmentation. Hydroquinone is the most common topical cream. It is available OTC in 2% strength and 4% with a prescription. Other products your Provider might use in combination with hydroquinone or alone include kojic acid, azelaic acid, hydroxyl acids, and retinoids. The main goal of these topical creams is to lighten the patches.

Other treatment options include chemical peels such as Glycolic acid or a Jessner peel. A Jessner peel uses a powerful blend of salicylic acid, lactic acid, and resorcinol to effectively treat conditions such as acne, melasma, and sun damage.

Intense pulsed light (IPL) is another option. IPL is a good procedure due to minimal downtime and relatively low-risk factors. These can be performed monthly until desired effects are achieved. Treatments using a Fraxel® laser can also be helpful by resurfacing the upper layers of the skin, promoting new skin cell growth, and lightening the skin’s pigment.

If hormonal issues are triggering your melasma, such as taking birth control medication or hormone treatments, you might want to discuss it with your Provider to see if there are other options you can explore. Melasma can fade after a person stops taking these types of medications.

The key to any treatment is patience. Seeing results may take time, and you may need a combination of treatments depending on your situation.

Taking Care of Yourself

As with any chronic skin condition, being consistent with your treatments, working in conjunction with your Provider, and being proactive in taking care of your skin, will help you manage your melasma.

It cannot be stressed enough that UV protection is key to preventing melasma, minimizing the appearance of existing dark spots, and preventing it from reoccurring if you have had treatment. This means using sunscreen daily, regardless of the weather, season, or if you think you don’t need it because you’re going straight to work. Remember that UV rays penetrate glass, so you will be getting the effects of UV rays through car windows and the office window you may be sitting next to. A broad-spectrum UVA/UVB sunscreen is critical, with a zinc and/or titanium sunblock and an SPF of over 30. Reapply often during the day.

Maintaining a good skin care routine will also keep your skin healthy. Besides sunscreen protection, using a mild skin cleanser and moisturizing can keep your skin barrier up to par. Your Board-Certified Dermatologist or Advanced Practitioner may be able to recommend skin products that work best for you.

Melasma can be a frustrating chronic skin disorder. However, multiple treatment options are available to help control those brown patches on your skin. Don’t let it get you down!

Consult with one of our Board-Certified Dermatologists or Advanced Practitioners to get an accurate diagnosis and individualize your treatment. At Advanced Dermatology & Skin Cancer, our expert Providers have years of experience in treating skin conditions. You can book an appointment at one of our locations if you have any questions or concerns.


Jeanne Ellern, PA-C, is a native of Spokane and has been practicing in the area since 1998, with over thirteen years of experience in dermatology. Her specialties are medical dermatology, skin cancer treatments, and cosmetic dermatology. Jeanne chose dermatology because of the diverse challenges encountered when dealing with skin conditions. She knows that her patients’ skin health significantly impacts their overall well-being. Jeanne also enjoys spending time outdoors with her husband Razor riding and fishing. Hobbies include quilting and cross-stitch.