Melasma and other types of facial hyperpigmentation


Facial hyperpigmentation can be a significant concern and have an impact on self-confidence and daily life. There are various types of facial discoloration, and melasma is one of the most common. It manifests as flat, brown areas on the face that are often symmetrical and become more noticeable after exposure to the sun.

While these changes to the skin’s appearance may be distressing, understanding the nature of melasma and other forms of facial hyperpigmentation, as well as their causes and treatments, can be empowering.

In this blog, you’ll learn more about facial hyperpigmentation, what causes melasma, and the various treatment options available.

What is facial hyperpigmentation?

Facial hyperpigmentation is a condition where patches of skin become darker. This occurs when the skin produces an excess amount of melanin, the pigment responsible for skin colour.

It can affect any skin type and is more likely to occur during specific times such as pregnancy, age, or following an injury. Among the various manifestations of hyperpigmentation, melasma is the most common, known for its brown or greyish patches, typically on the face. Often, it can be confused with sun/age or liver spots. However, these dark spots are caused by repeated sun exposure and not influenced by hormones.

Melasma, also referred to as ‘chloasma’ or ‘pregnancy mask,’ is neither contagious nor cancerous, and it’s not an infection or allergy. It usually affects mainly women, especially during pregnancy, but men can also be affected.

What causes melasma?

The cause of melasma isn’t fully understood, but it is believed to result from the skin’s pigment-producing cells (melanocytes) creating too much melanin. While it can affect anyone, those with naturally darker skin tones are more likely to experience the condition. Several contributing factors can lead to its development, including hormonal changes from pregnancy, birth control pills or hormone replacement. Also, occasionally, medical problems affecting hormones, such as thyroid issues.

Some medications, like antiepileptics, may also cause the condition. Exposure to ultraviolet (UV) light, whether from the sun or artificial sources like sunbeds or phototherapy, can trigger or exacerbate melasma.

It’s worth noting that while melasma is more common in those with a family history, it is not considered hereditary.

How to treat melasma

While there’s no permanent cure for melasma right now, several treatment options can improve its appearance. If it occurs during pregnancy, it might naturally fade post-delivery, though it can return with subsequent pregnancies. Keep in mind that during pregnancy, certain treatments like hydroquinone and retinoid creams must be avoided due to potential harm to the foetus.

Various approaches can be effective in treating melasma, including avoiding known triggers like birth control pills and hormone therapy, or using sun-blocking creams to shield against UV exposure.

Options such as chemical peels, laser therapy, skin lightening creams, micro needling, and skin camouflage, can also be considered. However, sometimes even with successful treatment, it can return once the treatments are stopped. Therefore, ongoing management of the condition may be required.

More recently, evidence has suggested that oral tranexamic acid is an effective treatment for melasma, and research is underway to evaluate topical tranexamic acid to treat the condition.

If you are struggling to manage your melasma, or you suspect your skin troubles are down to hyperpigmentation, book an appointment with Dr Juliet Williams by emailing