The Truth About Melasma and What Causes Dark Patches on Your Skin

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The Truth About Melasma and What Causes Dark Patches on Your Skin

If you’ve noticed persistent brown or gray-brown patches appearing on your face, particularly on your cheeks, forehead, or upper lip, you’re not alone. Melasma affects an estimated 15 to 50 per cent of pregnant women and is increasingly common among women aged 20 to 40. These stubborn dark patches can significantly impact confidence and self-esteem, yet many people struggle to find clear answers about what’s causing them. In this guide, you’ll discover the underlying causes of melasma, identify your personal triggers, learn evidence-based prevention strategies, and explore modern treatment approaches. While over-the-counter products may provide some improvement, consulting the best private dermatologist in London ensures you receive an accurate diagnosis and personalised treatment plan tailored to your unique skin concerns.

What Is Melasma? Understanding the Condition

Melasma is a chronic hyperpigmentation disorder characterised by symmetrical patches of increased pigmentation on sun-exposed areas of the skin. Unlike temporary discolouration, melasma creates persistent brown, gray-brown, or bluish patches that typically appear across both sides of the face.

The most commonly affected areas include the cheeks, the bridge of the nose, the forehead, the upper lip, and the chin—a distribution pattern nicknamed “the mask of pregnancy.” However, this term is misleading, as the condition affects many individuals who have never been pregnant.

Understanding melasma requires distinguishing it from other forms of hyperpigmentation. Sun spots are typically smaller, isolated dark spots caused by cumulative sun exposure. Post-inflammatory hyperpigmentation occurs after skin injury, such as acne. Melasma develops without prior injury and is primarily driven by hormonal influences combined with sun exposure.

Melasma predominantly affects individuals with Fitzpatrick skin types III through VI, meaning those with olive, brown, and darker skin tones face a higher risk. Women are affected approximately nine times more frequently than men, with peak onset between ages 20 and 40.

The Science Behind Melasma: What Causes Dark Patches

Primary Triggers

Hormonal fluctuations are the most significant trigger of melasma. Pregnancy causes dramatic hormonal changes that stimulate melanocyte activity, explaining why up to 50 per cent of pregnant women develop melasma. Birth control pills and hormone replacement therapy produce similar effects. The connection is so strong that melasma often improves after pregnancy or when hormonal medications are discontinued.

UV exposure acts as both a trigger and an aggravator. Ultraviolet radiation stimulates melanocytes, leading to excess melanin production. Even brief sun exposure can darken existing patches or trigger new ones, explaining why melasma worsens during summer months.

Genetic predisposition plays a crucial role. If close relatives have melasma, you face a significantly elevated risk. Certain ethnic backgrounds show higher prevalence rates.

Secondary Contributing Factors

Heat exposure from cooking, hot environments, or very hot water can stimulate melanocyte activity. Blue light from screens may contribute to pigmentation, though research continues. Certain skincare products that irritate can worsen pigmentation by increasing inflammation. Photosensitising medications can exacerbate melasma, and thyroid dysfunction has emerged as another potential factor.

The Cellular Process

Melasma involves abnormal melanocyte activation and increased melanin production. Multiple factors stimulate these pigment-producing cells to create excess melanin deposits in the skin’s upper layers. This melanin can penetrate deeper layers, making melasma particularly stubborn and prone to recurrence.

Common Myths vs Facts About Melasma

Myth: Melasma only affects pregnant women
While pregnancy is a significant trigger, melasma affects many who have never been pregnant, including men. Any hormonal influence can trigger the condition.

Myth: Melasma will fade on its own
Pregnancy-related melasma may improve after delivery but rarely disappears completely. Without proper treatment and sun protection, melasma typically persists and may worsen.

Myth: All dark patches are the same
Different hyperpigmentation types require different treatments. Professional diagnosis ensures you receive appropriate treatment for your specific condition.

Prevention Strategies: Protecting Your Skin

Preventing melasma centres on comprehensive sun protection and lifestyle modifications.

Daily broad-spectrum SPF 50 or higher sunscreen is essential. Mineral sunscreens containing zinc oxide or titanium dioxide physically block UVA and UVB rays. Apply every morning, reapply every two hours outdoors, and don’t forget your hairline, ears, and neck.

Physical sun protection enhances sunscreen effectiveness. Wide-brimmed hats, UV-protective sunglasses, and seeking shade during peak hours provide additional defence.

Adopt a gentle skincare routine using fragrance-free, non-irritating products. Avoid harsh scrubs that can trigger inflammation. Managing heat exposure by staying cool helps prevent melanocyte activation.

If prone to melasma, discuss contraceptive and hormone therapy options with your healthcare provider, as some formulations may be less likely to trigger pigmentation.

Modern Treatment Approaches

Successfully treating melasma requires a multifaceted approach combining topical treatments with professional interventions. Effective melasma treatment begins with understanding that no single solution works for everyone, which is why personalised care is essential.

Hydroquinone remains the gold standard, effectively inhibiting melanin production under professional supervision. Tretinoin and retinoids accelerate cell turnover, fading existing pigmentation. Azelaic acid, kojic acid, and vitamin C offer additional lightening benefits. Tranexamic acid shows promising results in recent studies.

Professional treatments provide intensive intervention. Chemical peels using appropriate formulations accelerate pigment removal but must be carefully selected for darker skin tones. Laser therapy requires caution, as certain types can worsen melasma—personalised prescription formulations tailored to your skin type offer targeted treatment.

Professional assessment ensures accurate diagnosis, individualised treatment planning, monitoring for side effects, and treatment adjustments based on your response. A qualified dermatologist can investigate underlying contributing factors.

Living with Melasma

Melasma is a chronic condition requiring ongoing management rather than a quick fix. Consistent treatment and sun protection are essential for maintaining results. Expect seasonal variations, with patches often darkening in summer despite preventive measures. The emotional impact of visible pigmentation is valid—seeking professional support ensures both effective treatment and improved confidence in managing this common but challenging skin condition.