Dark Spots on Face (Melasma): Causes and Treatment - Health.com

You may have dark spots on your face due to melasma, a skin condition in which patches of brown spots appear on the skin. Those patches—also known as hyperpigmentation, a general term for skin discoloration—tend to appear on the cheeks, chin, forehead, nose, and upper lip.

Although the patches may cause concern, melasma isn't dangerous. While it can affect anyone, melasma most commonly occurs in people with dark skin tones. It often appears during pregnancy and is known as chloasma and the "mask of pregnancy."

You can treat the condition for cosmetic reasons if you're wondering how to get rid of the dark spots on your face. Sun protection, however, is key to reducing the appearance and preventing melasma. Here's what you need to know.

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With melasma, treatment goals include reducing melanin production and evening out your skin tone. The time it takes to achieve those goals varies, but you may see results within three to 12 months. Some melasma treatments include:

  • Sun protection: Wear a water-resistant, broad-spectrum sunscreen with an SPF of 30 or more daily. Sunscreens with zinc oxide, titanium dioxide, and iron oxide help with melasma. Tinted sunscreens with iron oxides can also be protective against visible light for the skin. Sun protection can help reduce the appearance of and prevent melasma.
  • Medicines: Hydroquinone helps even out your skin tone. A healthcare provider may also recommend tretinoin and a mild corticosteroid. In some cases, they may advise using a cream that consists of all three ingredients. Other medicines include azelaic acid, kojic acid, and vitamin C.
  • Chemical peels: These lift off some of the surface pigment.
  • Microneedling: This type of treatment increases the absorption and efficacy of topical medicines.
  • Lasers: Using heat, this treatment targets and breaks up pigment—but know that heat can also trigger melasma. Lasers that don't generate too much heat are key to treating the condition. 
  • Platelet-rich plasma: A healthcare provider injects your blood plasma into the affected area with this procedure. 
  • Tranexamic acid: For severe cases of melasma, a healthcare provider may advise using tranexamic acid. This medicine is available as a topical solution or oral pill. 

You can additionally conceal melasma with makeup. A healthcare provider may advise first applying your medicine, then sunscreen and any makeup to conceal the affected area.

What Symptoms May Treatment Resolve?

Melasma causes dark spots on the face, usually appearing on the cheeks, chin, forehead, nose, and upper lip. People may still notice melasma on their jawline, neck, and arms. In people with lighter skin tones, melasma may appear brown. People with darker skin tones may notice bluish-gray patches.

Characteristics of melasma include:

  • Patches that appear darker than your natural skin color
  • Symmetrical patches (e.g., patches that develop on both sides of the face)
  • Large patches of darker skin
  • Areas that appear more prominent on certain body parts than others (i.e., the jawline)
  • Improvements in pigmentation during fall and winter compared to spring and summer due to sun exposure

In addition to skin color changes, melasma may lower self-esteem. Some people with skin conditions that alter their appearance have a high risk of anxiety and depression.

There are several why melasma occurs, such as:

  • Sun exposure: The sun's ultraviolet (UV) rays play a primary role in all types of hyperpigmentation, including melasma. UV rays, visible light, and heat all activate melanocytes to make more melanin. 
  • Tanning beds: Using tanning beds exposes you to artificial UV rays stronger than the sun's UV rays.
  • Pregnancy: Estrogen and progesterone play a role in melasma. Both hormones affect melanin production, and their levels rise during pregnancy, producing even more melanin.
  • Certain medications: Like pregnancy, birth control pills and hormone replacement therapies can trigger melasma by increasing estrogen and progesterone. Some retinoids, antibiotics, and blood pressure medicines make your skin sensitive to the sun's UV rays. In addition, certain anti-seizure drugs may trigger melasma.
  • Stress: In some cases, stress triggers melasma by increasing cortisol levels.
  • Thyroid dysfunction: Typically, your thyroid makes hormones that regulate your metabolism and heart rate. An underactive or overactive thyroid may trigger melasma.

Anyone can develop melasma. However, some people have a higher risk than others. Melasma risk factors include:

  • Sex: The hormones estrogen and progesterone trigger melasma. The condition is more common in those assigned female at birth.
  • Skin tone: People with dark skin tones make more melanin than others. 
  • Family history: Having blood relatives with melasma also increases your risk.

How Is It Diagnosed?

A healthcare provider can diagnose melasma by examining your skin. For example, they may use a Wood lamp to look at the affected area more closely.

The healthcare provider will hold the Wood lamp about five inches from your skin in a dark room. The Wood lamp shines UV light on your skin, which helps examine skin color changes.

The provider may also order blood tests to check your hormone levels. A blood test can tell whether thyroid dysfunction, pregnancy, or oral contraceptives contribute to melasma.

A healthcare provider will also take steps to rule out other skin conditions if they cannot confirm melasma. For example, they may obtain a sample of your skin for a biopsy.

Some risk factors, like family history or natural skin tone, cannot be modified. One risk factor that you can control is sun exposure. 

Protecting yourself from the sun's UV rays is one of the best ways to prevent melasma. Use a water-resistant, broad-spectrum sunscreen with SPF 30 or more daily, reapplying at least every two hours in the sun. 

Wear broad-rimmed hats, seek shade, and avoid the sun as much as possible. Not using tanning beds is key as well.

Melasma is not a fatal or harmful condition. Researchers have not found any malignant cases of melasma. Some evidence has suggested that melasma might lower the risk of melanoma, a severe type of skin cancer.

Keep in mind that it may take time for melasma to reduce after stopping hormone medicines or giving birth. Melasma may also return if you start taking those medicines or get pregnant again.

One of the best ways to minimize melasma is to lower sun exposure. Research has found that avoiding the sun's UV rays can help reduce the appearance of melasma and prevent it from returning.

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