Have you noticed some dark patches on your forehead, chin, cheeks, lip or nose?

An estimated 6 million American women are affected by melasma, or hyperpigmentation — dark spots that appear on certain areas of the skin when pigment-producing cells become hyperactive. It’s similar to what causes brown age spots and freckles, but melasma patches tend to be larger.

Melasma affects women primarily; just 10 percent of people who develop it are men, according to the American Academy of Dermatology. Women at all stages of life can be affected, but those who are pregnant, have darker skin types or a family history of melasma are more likely to develop it.

Often called the “mask of pregnancy,” melasma is commonly triggered by hormonal changes during pregnancy. The hyperpigmentation usually fades shortly after delivery but it may persist for years.

Hormonal medications (e.g., hormone replacement therapy) and hormonal contraception (e.g., birth control pills) can also cause it.

Exposure to the sun can trigger melasma as well. Even just a small amount of sun exposure can make the condition return after it faded. And it’s not just the sun’s rays that can cause or worsen it, but also heat. This means that sunscreen may not be enough to prevent it.

The primary symptom is discolored patches of skin, usually in a symmetrical pattern. The patches are common on the cheeks, upper lip, forehead and chin, and less common on the arms and neck. Although it isn’t painful, melasma can cause emotional distress.

In order to find effective treatment, the underlying cause needs to be addressed, as treatment won’t work if there are still triggers in place. For instance, some women on a hormonal contraception may need to switch to a non-hormonal option (e.g., the copper IUD).

Your dermatologist may recommend medications or topical treatments, or certain procedures, to help lighten melasma. Here are some ways you can help to reduce the risk:

• Limit sun exposure. Melasma will be quick to return if you're not careful about sun protection. When outside, wear a wide-brimmed hat, sunglasses and sun-protective clothing, and try to stay in the shade as much as possible.
• Follow a strict sunscreen regimen. Since sunlight triggers melasma, it is important to wear sunscreen every day, even on cloudy days, and after swimming or sweating. Use a broad-spectrum UVA/UVB sunscreen with zinc oxide and/or titanium dioxide. Apply sunscreen 15 minutes before going outside and reapply at least every two hours.
• Be careful when choosing products. Some skin-lightening products, including oral or injected products, can be unsafe or worsen melasma. Choose gentle skin care products that don’t sting or burn to avoid irritation.
• Avoid waxing. Waxing on areas of the body affected by the condition may cause skin inflammation which can worsen melasma. Ask your dermatologist about other forms of hair removal.
• Clean and moisturize your skin regularly. Environmental pollution can contribute to melasma. Use a good moisturizer to restore the skin’s health and protect it from damage. Look for a serum with antioxidants, such as vitamins C and E, which can help heal damage to the skin from sunlight.

Be patient. Melasma can be stubborn. Sometimes it can fade on its own but other times, even with treatment, it may take months for the condition to clear up.

The only symptom of melasma is skin discoloration. If you also have pain, tenderness or itchy skin, consult your doctor.

Find a dermatologist.

Learn about pregnancy and baby services at Edward-Elmhurst Health.

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