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MELASMA
WHAT IS MELASMA?
Melasma is a form of hyperpigmentation characterised by brown or greyish-brown patches, typically across the cheeks, forehead, upper lip, and jawline. These areas of pigmentation usually have indistinct borders, developing gradually and then deepening over time.
Unlike isolated sun spots or freckles, melasma is influenced by internal and external factors, including hormonal changes, heat, and light exposure. This is why pigmentation may fluctuate and is more commonly seen in women and those with medium to darker skin tones.
Although melasma is considered benign, it can be persistent and prone to recurrence. Understanding what stimulates pigment activity is an important step in supporting longer-term stability and a more even-looking skin tone.
COMMON CAUSES OF MELASMA
Melasma develops when melanocytes (the cells responsible for producing melanin) become overactive. Rather than being driven by a single factor, melasma usually occurs when several influences combine to increase pigment production.
Melasma is commonly associated with:
Triggers and contributing factors
While hormonal and pigment pathways drive melasma at a cellular level, certain factors can worsen existing pigmentation or cause it to return after it has faded.
Common melasma triggers may include:
- Hormonal changes during puberty, menstruation, pregnancy, or menopause
- Hormonal therapy, including oral contraceptives or hormone replacement therapy
- Sun exposure, including ultraviolet, visible light, and especially high-energy blue light
- Heat exposure, such as hot climates, saunas, or hot yoga
- Certain medications that increase photosensitivity or alter hormones
- Environmental stressors, including pollution and cumulative sun exposure
- Psychological stress, which may influence hormonal and inflammatory pathways.
TYPES OF MELASMA
Melasma can present differently depending on how deeply the pigment sits within the skin. Understanding the type involved allows for a more considered treatment plan and helps set realistic expectations around how the skin may respond over time.
Melasma commonly presents as:
EPIDERMAL MELASMA
Epidermal melasma involves pigment located in the upper layers of the skin (the epidermis). Because the excess melanin sits more superficially, it often appears brown in tone and may respond more readily to topical treatments and carefully staged clinical therapies that target surface pigmentation.
DERMAL MELASMA
Dermal melasma involves pigment located in the deeper layers of the skin (the dermis). Because the excess melanin sits further below the surface, it often appears more grey or blue-grey in tone and can be slower to respond to treatment. Management typically requires a gradual and conservative approach guided by pigment depth.
MIXED MELASMA
Mixed melasma involves pigment present in both the upper and deeper layers of the skin. This combination often results in variations of brown and grey-brown tones within the same area. Because pigment exists at multiple depths, treatment plans are usually layered and adjusted over time based on how the skin responds.
YOUR FREQUENTLY ASKED QUESTIONS
Here, our dermal clinicians answer some of your most common questions about melasma, its causes, and how it can affect the skin. For personalised guidance, you’re always welcome to contact the clinic.
Because melasma is considered a chronic condition, you can’t usually get rid of it completely. Even after visible pigmentation improves, the pigment-producing cells can remain more reactive. This means melasma can still be triggered.
Rather than focusing on a quick fix, effective melasma treatment involves gradually regulating pigment production, protecting the skin from stimulation, and maintaining results over time.
To understand which treatment options may be suitable for your skin, you can explore our melasma treatment page, where we outline medical and clinical approaches in more detail.
At this stage, there’s limited direct evidence linking specific foods to melasma. That said, in some individuals, foods that trigger flushing or increase overall inflammation may indirectly influence pigmentation, particularly when combined with heat or sun exposure.
Instead of strict elimination diets, many people find it more helpful to observe personal patterns over time. If you suspect certain foods may be contributing to changes in pigmentation, this can be discussed as part of a broader management plan.
In some cases, melasma may lighten on its own, particularly if it developed during pregnancy or alongside temporary hormonal changes. When hormone levels stabilise, pigmentation can fade naturally over time.
However, for many people, melasma behaves as a fluctuating condition. Even when pigmentation improves, the pigment-producing cells can remain more reactive than usual. This means discolouration can return.
With consistent management and protection, melasma can often be stabilised and visibly reduced, even if it does not resolve completely.
Although these conditions all involve increased pigment, they differ in cause, pattern, and behaviour.
Sun spots (solar lentigines) are typically well-defined and develop due to cumulative ultraviolet exposure. Freckles are smaller, discrete spots that often appear earlier in life and darken with sun exposure. Post-inflammatory hyperpigmentation develops after skin injury or inflammation.
Melasma, by contrast, usually presents as larger, symmetrical patches influenced by hormonal activity and light exposure. Distinguishing between these forms of pigmentation is important, as treatment strategies differ.
During pregnancy, hormonal changes (particularly increases in oestrogen and progesterone) can stimulate melanocytes to then produce more melanin. When combined with light exposure, this can lead to the development or darkening of melasma, sometimes referred to as “pregnancy mask.”
In some cases, pigmentation may soften once hormone levels stabilise. In others, it can persist and require ongoing management. Any treatment approach during or after pregnancy should be carefully selected, with safety as the priority and in consultation with your doctor.