Melasma on Darker Skin

Melasma is a skin pigmentation disorder characterized by dark spots and patches on the face and other skin often exposed to the sun. While it can affect all people, people with darker skin have a significantly higher risk of developing this discoloration, and women represent up to 90% of cases. Though melasma doesn’t harm your health, its effects on your appearance can impact your self-esteem and feelings of self-worth.

As with other dermatological and medical issues, there are specific considerations unique to darker skin types when it comes to the treatment and management of melasma. For people with darker skin, it’s important to understand the basics of how this condition affects you, as well as what can be done about it. This article covers the causes, symptoms, risk factors, diagnosis, as well as medical and at-home management options for melasma.  

Facts About Melasma on Darker Skin

As with other dermatological conditions, there are some popular misconceptions when it comes to melasma. The key to living with and managing it is to separate the facts from the fiction about this condition.

Melasma

It Can Affect All Skin Types

Because it most often arises in people with darker skin, some think of melasma as exclusive to non-white populations. Indeed, a vast majority of cases are seen in these populations, and South America and Central America, Southeast Asia, northern Africa, and the Middle East have higher rates than other regions.

However, this disorder can also arise in those with lighter skin.

Melanocytes and Melanin

Fundamentally, melasma is a disorder of the melanocytes, which are skin cells that affect pigmentation. These cells are primarily found in the basal layer of the epidermis, or outer layer of skin.

People may confuse melanocytes with what they produce and store: melanin. This is a brown pigment that gives skin its pigmentation, so those with darker skin have higher amounts of it. In melasma, these cells are hyperactive, causing spotting and discoloration.

Melasma in Pregnancy

While melasma doesn’t only affect pregnant people, the hormonal changes that occur during pregnancy may set off this pigmentation disorder. This is why this condition is sometimes referred to popularly as “the mask of pregnancy.” If you’re expecting—and especially if you’re a person with darker skin—you’re at a much higher risk of experiencing melasma.

Melasma Can Fade

In many cases, melasma can fade on its own, without treatment. For instance, people who are pregnant may find the discoloration goes away after delivery due to hormonal shifts in the body. Additionally, since sun exposure can lead to melasma, patches and spots can get darker during the summer months. In cooler times of the year, the melasma will be less prominent.

Melasma Is Not Cancerous

Unlike some other dermatological conditions, melasma is not a sign of skin cancer, and it doesn’t increase the risk of developing it. However, significant discoloration is associated with cancer formation and can look similar, which is why medical attention is necessary.  

Melasma Likely Isn’t Associated With Thyroid Disease

Melasma isn’t reliably associated with other clinical conditions or diseases and generally doesn’t have complications. While some studies have found it associated with thyroid disease, subsequent research hasn’t found higher rates in people with the condition.

Symptoms of Melasma on Darker Skin

Appearance

Since melasma is a disorder of the melanocyte cells that regulate pigmentation, it most prominently affects the appearance of the skin. If you have darker skin, this condition appears as brown, gray, or blue patches or dots. Sometimes, the discolored can become reddish brown due to the underlying blood vessels that can sometimes be more prominent in melasma.

Location  

Melasma usually develops on parts of the skin that get more sun exposure, and it’s categorized based on its location on the body. Here’s a breakdown:

• Centrofacial: The most common area affected by melasma is the face, especially the forehead, nose, upper lip, and cheeks.
• Lateral cheek pattern: Melasma can also affect the cheeks, typically appearing on both sides of the face.
• Malar: Malar melasma affects the cheeks and nose.
• Mandibular: Mandibular melasma arises along the jawline.
• Neck: Melasma can also form on the neck; this is typically seen in those ages 50 or older.
• Brachial: This type affects the upper arms and shoulders.

Causes of Melasma on Darker Skin

Melasma develops due to disorders of melanocytes, the cells that produce skin pigmentation. Essentially, discoloration is produced when these are overactive, emitting excess amounts of brown pigment (melanin). Since those with darker skin have more of these, they are more likely to experience the condition. This overactivity is worsened by skin exposure to ultraviolet (UV) rays in sunlight as well as changes in hormonal activity.

Risk Factors

Researchers have identified several risk factors for developing melasma. The following groups are more likely to develop this condition:

• Age: While this condition can develop any age, adults in their 20s and 30s most frequently develop it.
• Sex: About 90% of melasma cases are seen in people assigned female at birth, as changes in levels of the sex hormones estrogen and progesterone can contribute to it.
• Pregnancy: Related to the above, the hormonal shifts during pregnancy—as well as those when starting or stopping birth control drugs—make people more susceptible to this condition.
• Genetics: Up to half of those reporting melasma have a relative with it, implying a strong genetic component.
• Medications: Some drugs cause skin hypersensitivity to light, which can lead to melasma development. These include nonsteroidal anti-inflammatory drugs (NSAIDs), some antibiotics, diuretics, antipsychotic medications, and hypoglycemics, among others. Certain antiseizure medications (anticonvulsants) can also set off the condition.
• Cosmetics and skin-care products: Some makeup and skin-care products can increase your skin’s light sensitivity, causing what’s called a “phototoxic” reaction. In turn, this can be damaging to the skin and lead to melasma.

When to See a Healthcare Provider

While melasma, itself, isn’t dangerous, spots or patches of discoloration can be signs of other conditions, both benign and problematic. These include:

• Some types of skin cancer
• Lupus (an autoimmune disease in which the immune system attacks healthy tissues in the body)
• Lichen planus (in which the immune system attacks the skin)
• Freckles
• Lentigo (age spots)
• Drug-induced pigmentation changes

Medically speaking, then, it’s crucial to get skin changes examined to ensure you don’t have a more serious disease. In addition, since melasma affects your appearance, it can impact your confidence and sense of self-esteem. It’s worth exploring your options in these cases, too.

Physical Examination

The diagnosis of melasma involves several kinds of assessments, and it may be more challenging to identify in those with darker skin. This may involve: 

• Health history and assessment: A big part of diagnosing melasma is to rule out other causes of discoloration. This will mean assessing if you have a family history of the condition, what medications you’re taking, as well as your current health status.  
• Wood’s lamp: Especially helpful for determining if melasma is superficial or deep, a specialized UV ray-emitting device called a Wood’s lamp. Basically, this is a black light that brings out subtle differences in pigmentation, making diagnosis easier.
• Biopsy: If cancer is suspected, your doctor may call for a biopsy. This is a lab examination of a small sample of skin removed from an affected area.

Questions to Ask

Making sure you’re informed about your condition and able to advocate for yourself is essential for the management of melasma. If you do see a healthcare professional such as a dermatologist (doctor specializing in conditions of the skin, hair, and nails) about your case, consider asking questions such as:

• Do I have melasma or are my symptoms from another skin condition?
• What vitamins and medications can I take to help with melasma?
• How much sun exposure is safe for me?
• What is a good sunscreen for me to use?
• Are certain soaps or skin-care products I’m using making it worse?
• What sort of birth control won’t affect my skin?
• What medications or supplements should I avoid?

Management and Skin Care Tips

While melasma resolves on its own is some cases, it often persists, and there’s no outright cure. However, along with medical treatments and medications, there’s a lot you can do to manage this condition. This will mean mixing and matching strategies to find what works for you.

Treatment Options

The first line of managing melasma involves developing prevention and home-management strategies, including avoiding certain triggers. Limit your exposure to or avoid the following:

• Sunlight: Avoid direct sunlight exposure to the skin by wearing long sleeves, hats, and using darker fabrics. Use strong sunscreen with a sun protection factor (SPF) of 30 to 50 that’s made with iron oxide. Reapply every two hours.
• Birth control: Birth control or estrogen therapy can change your hormone levels, leading to melasma. Changing what you’re taking may help.
• Certain soaps and cosmetics: Some soaps and skin-care products can also irritate the skin and make melasma worse. Scented soaps and some kinds of makeup can be especially problematic,
• Tanning beds and/or waxing: Certain beautifying treatments can also aggravate melasma, such as tanning beds or wax hair removal.

Along with the above, there are a number of medications that can be prescribed to help. These include:

• Hydroquinone: A topical treatment, meaning it’s applied directly to the affected skin, hydroquinone is a cream put on affected patches at night.     
• Hydrocortisone: Hydrocortisone is a topical steroid that can also help ease the severity of outbreaks, while also managing dermatitis that can be a side effect of other treatments.
• Azelaic acid: This cream is applied once or twice daily to manage the symptoms. It is safe for pregnant people to use.

Lastly, other medical treatments may help, especially when paired with medications. These include:

• Topical alpha hydroxy acid: This essentially is a chemical peel for the skin. This removes the outer layers of skin, which can clear away melasma spots and blotches.  
• Laser/light treatments: Dermatologists may use specialized lasers to help with the discoloration. In darker skin types, many lasers are not safe for melasma. If you are considering laser treatment, it is important to see a dermatologist who is experienced in treating melasma with lasers in people with darker skin.

Summary

Melasma is a skin pigmentation disorder characterized by the development of blue, gray, black or blue patches on the skin. Arising due to exposure to sun, genetics, and hormonal shifts, the condition can affect all people but is most seen in women and people with darker skin.

Though this condition is painless and doesn’t cause complications, it can resemble more dangerous issues and affect your appearance. Melasma is a chronic condition, but there are treatments available. Treatment often involves mixing strategies that range from using certain medications to working to prevent the onset to medical procedures, such as chemical peels.

It’s important to be able to advocate for yourself and seek the treatment you need.

A Word From Verywell

While melasma is one of the most common skin pigmentation disorders, the medical community has some catching up to do. If you have darker skin, it’s important not only to seek medical care but also to be your own advocate. By being proactive, you’ll set yourself on the road to recovery from melasma.