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Overview of Melasma: Symptoms, diagnosis, and treatments

Team AckoJan 17, 2024

Unfortunately, the Indian skin tone is extremely prone to developing skin pigmentation. One of the most common concerns is Melasma, a typical butterfly-shaped pigmentation seen over the forehead, nose, cheeks, and chin. Studies show that up to one-third of the population has Melasma. During pregnancy, this number shoots up drastically. About 50 to 70% of pregnant women develop Melasma. One of the most difficult parts of treatment is that the pigmentation resolves extremely slowly. Patients often get impatient and tend to experiment with various home remedies and over-the-counter products. These can even worsen the condition in some cases. Thus, it’s crucial to understand Melasma, and this article will help you do so.




What is Melasma?

Melasma is a very common skin condition seen mainly in women in which dark-coloured patches are seen mainly over the cheeks and the nose. These patches are symmetrical and appear on both sides of the face.

Melasma occurs very commonly during pregnancy. At this time it is called chloasma or the “mask of pregnancy”. Because of this observation, theories state that Melasma may develop because of hormonal changes in the body.

Another important factor in triggering this pigmentation is UV radiation. We already know that long hours in the sun without protection causes skin tanning. However, it also increases the production of melanin (a pigment that gives colour to the skin). Taking certain medications that make you sensitive to sunlight can increase the chances of developing Melasma. Other causes of Melasma include genetics, use of contraceptive pills, hypothyroidism, etc.

Types and symptoms of Melasma

There are three types of Melasma depending on the level of deposition of the pigment melanin. The pigment can be deposited in the upper layers of the skin. This is called epidermal Melasma and looks light brown in colour. When melanin is deposited deeper in the skin it is called dermal Melasma. This gives a darker brown or bluish appearance. Sometimes a combination of the two can be seen called a mixed pattern. The importance of this is that typically epidermal Melasma responds to treatment better.

Melasma is primarily a cosmetic concern owing to the patchy pigmentation on the face. However, severe cases of Melasma have been found to have a significant psychological impact on patients. Hence, the importance of treating the condition should not be underestimated.

How is Melasma diagnosed?

Melasma is diagnosed clinically by a dermatologist. Sometimes, your doctor may use a Woods lamp to see the level of pigmentation. This is a specialised light that uses ultraviolet radiation to see skin lesions.

What are the treatment options for Melasma?

Here’s where things get tricky. If you’ve ever visited a salon, you might have heard people promote a multitude of creams and procedures with claims that they can clear all your pigmentation. That is not the case with Melasma.

The treatment of Melasma can last for 3 to 6 months minimum. Also, if the pigmentation is deep, it’s best to consult a doctor. Some home remedies can be extremely harsh on the skin and can cause permanent damage.

1. Sunscreen

Before you start anything else, there is one non-negotiable part of the treatment and that is sunscreen. A lot of people skip sunscreen because it makes their skin feel oily or they are mostly indoors. This should not be done. Look out for buzzwords like broad-spectrum and always check the SPF and PA rating to ensure you get a good quality sunscreen. A minimum SPF of 30 is recommended. Nowadays, sunscreens are available as gels, creams, lotions, sprays, etc. You can pick the one that suits your skin the best.

2. Topical treatment options

There are a lot of creams that doctors prescribe for Melasma. These are mainly targeted towards reducing the production of melanin or destroying melanocytes. The options for creams include those containing hydroquinone, azelaic acid, kojic acid, silymarin, etc.

There are a wide variety of botanical products that are promoted for their skin-lightening effects. These include mulberry extract, green tea extract, flavonoids, licorice extract, etc. A lot of people try to replicate these effects by directly applying vitamin C in the form of lemons on the face. This can cause severe irritation and must be avoided.

3. Medical treatment options

Apart from things you can do at home, there are procedures that a dermatologist can perform to reduce Melasma. These include chemical peels and lasers. Nowadays, doctors also prescribe oral medications such as tranexamic acid for Melasma. Such tablets should only be taken in the recommended dose with a good understanding of potential side effects.

A word of caution

Here are some of the common mistakes that people make while treating Melasma because of misconceptions.

  • Not applying enough sunscreen: Patients often take a small amount of sunscreen and spread it. As a rule of thumb, you need about one teaspoon of sunscreen to cover your entire face and neck. This needs to be reapplied every 3 to 4 hours.

  • Constant switching products: Because there are so many treatment options available, patients tend to try a lot of new products without applying any of them for long enough. This can damage the skin. It is best to stick to one treatment plan after being evaluated by a professional.

  • Not using sun protection indoors: A lot of people who spend the whole day indoors in front of a computer screen skip sunscreen. An LED device can also worsen Melasma and appropriate measures should be taken.

  • Applying creams without knowing the contents: Topical steroids are one of the treatment options for Melasma. Unfortunately, they can cause permanent damage to the skin if used incorrectly or for a prolonged period of time. Another such cream is hydroquinone. While it is extremely effective in skin lightening, it can also result in a condition called exogenous ochronosis, a condition that is extremely resistant to treatment.

Melasma treatment options are getting updated constantly. Always consult a professional to get a safe and effective treatment plan. 

Frequently Asked Questions (FAQs)

Here’s a list of common questions and answers related to Melasma


How can Melasma be cleared permanently?

Unfortunately, there is no treatment that can guarantee a permanent cure. You will still need to use some creams for maintenance and apply sunscreen regularly. Melasma can reappear at any time, especially after increased sun exposure.

How long does the treatment for Melasma last?

Depending on the type of Melasma and the duration, the treatment may last for up to six months.

Can Melasma treatment be taken during pregnancy?

There are a lot of treatment options for Melasma. Some of them are safe during pregnancy, whereas others are not. It’s best to ask a professional for the correct treatment during pregnancy.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.


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