While melasma isn’t painful and doesn’t present any health risks, it can cause significant emotional distress. Melasma can be difficult to treat, and there’s a lot of misinformation about what causes it.
You’re more likely to get melasma if you have a darker skin type because your skin naturally has more active pigment-producing cells, according to the American Academy of Dermatology. Melasma appears when these cells become hyperactive and produce too much pigment in certain areas of the skin. The mechanism is similar to what causes brown age spots and freckles, but melasma patches tend to be larger.
Melasma is more common in women, but it can also affect men. It may have a genetic component, as it often runs in families.
Fluctuations in certain hormones can cause melasma, which is why it commonly occurs during pregnancy. Melasma may also occur when you either start or stop hormonal contraception, including birth control pills, or when you take hormone replacement therapy.
The sun is the big culprit in triggering melasma – the sun is the major exacerbating factor, whatever the underlying cause. Melasma can be caused or worsened by not only the sun’s rays, but also heat and visible light. Even sunscreens that protect against skin cancer aren’t enough to ward off melasma which makes treating melasma a challenge, particularly in summer.
The first step in treating melasma is confirming that your darkened skin patches are indeed melasma, and determining what’s causing it. Treating melasma is unlikely to be effective if the underlying cause isn’t addressed. Oral treatments that now exist for severe cases of melasma can be pointless if there are still triggers in place.
It takes a thorough medical history to find out what’s causing the melasma. If a hormonal contraceptive is causing the problem, a woman might consider switching to a nonhormonal option, such as a copper intrauterine device.