Spots on the face are most likely to be caused by a skin condition known as melasma. Melasma is a common, patchy brown, tan or blue-gray skin discoloration due to overproduction of pigment on the skin.
Melasma typically results from sun exposure and hormonal changes in women due to progesterone and estrogen, and about 9 of 10 people with melasma are women ages 20 to 50, according to dermatology specialist Romeo Morales, MD, Romeo E. Morales, FAAD, board-certified in dermatology and specializes in clinical dermatology, skin cancer and skin immunology, with Advanced Dermatology PC.
Melasma is often referred to as the "mask of pregnancy" because its dark patches—which usually crop up on the nose, cheekbones and jaw—are even more prevalent while women are expecting. But that doesn't mean women greet the development of these embarrassing spots with the same type of glee as they do their babies-to-be.
According to the National Institutes of Health, about 6 million women in the United States are estimated to cope with melasma.
According to the National Institutes of Health, about 6 million women in the United States are estimated to cope with melasma, which has no permanent cure, but can be effectively treated. While hormonal changes and sunshine are the two biggest triggers, those with a genetic predisposition and darker skin are more prone to the condition. People who work around heat for example, such as cooks, may also be prone because of heat's ability to irritate the skin and induce overproduction of pigment.
"Most women who come to me with melasma are dismayed at their appearance," says Morales. "Melasma is not dangerous, but there's no question that it detracts from their quality of life."
Best treatment options for melasma
Melasma can fade on its own, particularly when the trigger causing it—such as pregnancy or oral contraceptive use—ends. But those who don't just want to wait and hope have several treatment options, Morales explains. They include:
- Hydroquinone. Available in a cream, lotion, gel or liquid, this medication works by lightening the skin. Hydroquinone can be found in over-the-counter preparations, but higher strength versions can only be obtained through a doctor's prescription.
- Tretinoin and corticosteroids. These medications enhance the skin lightening process when added to hydroquinone. Some contain three compounds—hydroquinone, tretinoin and a corticosteroid—which are then called a "triple cream."
- Other topical medications. Also applied to the skin, these may include the skin-lighteners azelaic acid or kojic acid.
- In-office procedures. When topical medications don't do the trick, dermatologists may use in-office procedures such as a chemical peel, microdermabrasion or dermabrasion treatment, which slough off the top layers of the skin. It should be noted that irritation itself could produce more pigment on the skin.
"With the help of a dermatologist, most melasma treatments result in good outcomes," Morales says. "Melasma can be stubborn and the topical treatments may take a few months to work, but patients are usually very happy with the results."
Prevention of melasma the best strategy
The catch? No melasma treatment offers permanent results, so Morales recommends maintenance therapy that can prevent melasma from coming back. Certain common-sense tactics can also help avoid melasma from developing in the first place, he says. These include:
- Daily sunscreen use. Since sunlight is one of the biggest triggers for melasma, daily sunscreen use is non-negotiable to keep it at bay. Choose a sunscreen with broad-spectrum protection with an SPF of 30 or higher.
- Outdoor hats. Broad-brimmed hats help keep rays off vulnerable parts of the face. Seek shade whenever outdoors, as well.
- Gentle skin care. Since products that irritate the skin exacerbate melasma, use gentle products that don't sting or burn.
"Melasma may not be completely preventable, even with the best skin care and precautions," Morales says. "But in the vast majority of cases, efforts to prevent it or treat it are successful at keeping those annoying spots away."