Hyperpigmentation is a common skin concern that can significantly impact self-confidence. One of the most frequent types we see in my dermatology practice is melasma, often called the “mask of pregnancy.” Melasma appears as irregular, brown or grayish patches most commonly on the cheeks, forehead, nose, and upper lip.
Melasma is a type of acquired hyperpigmentation caused primarily by hormonal changes. It often develops during pregnancy, but can also be triggered by birth control pills, hormone replacement therapy, and other hormonal shifts. Sun exposure is another major factor that worsens melasma.
While melasma is more common in women, especially those with medium to darker skin tones, men can also develop it. The patches usually have a symmetrical pattern and can look like a shadow or discoloration rather than a distinct spot or mole.
Because melasma is persistent, many patients feel frustrated when treatments don’t seem to work quickly. The skin’s natural turnover cycle is about 30 days, so it takes at least three months of consistent care before seeing noticeable improvement.
Managing melasma involves a combination of approaches:
- Sun Protection
This is the foundation of treatment. Broad-spectrum sunscreen with at least SPF 30 should be applied daily, year-round, regardless of weather. We often recommend tinted sunscreens containing iron oxide because they protect not only against ultraviolet rays but also visible light, which can worsen pigmentation. - Topical Treatments
Prescription creams often include ingredients such as hydroquinone, tretinoin, corticosteroids, or other agents that inhibit melanin production and promote skin turnover. These medications help fade dark patches gradually and safely when used under medical supervision. - In-Office Procedures
When appropriate, we may recommend chemical peels or laser treatments to accelerate pigment reduction. These treatments must be done carefully, especially in darker skin types, to avoid worsening pigmentation or causing irritation. - Lifestyle and Skin Care Routine
Gentle cleansing and moisturizing are important to maintain skin barrier health and avoid irritation. Harsh scrubbing or overly aggressive exfoliation can exacerbate melasma.
One case that comes to mind involved a patient who developed melasma after starting hormonal birth control. Once we identified the trigger, stopping the medication combined with a customized treatment plan allowed her skin to gradually clear.
Melasma is not dangerous, but it is chronic and requires ongoing management. The key to success is patience and diligence with sun protection and treatment adherence. We always encourage patients to come in with questions and concerns because individualized care and monitoring make all the difference.
If you notice persistent dark patches on your face, please schedule a consultation. Together, we can develop a safe and effective plan to restore your skin’s even tone and your confidence.
