Melasma causes blotches of darker skin, and usually occurs in women who have darker-toned skin to begin with. Although its exact cause is unknown, it can be triggered by hormones—particularly while pregnant—and is commonly called “the mask of pregnancy.” If caused by pregnancy, oral contraceptives, or other medications, melasma may fade after birth or discontinuation of hormone-containing medicine.2

There are three types of melasma, which are differentiated by the layer or layers of skin it occurs in:

  • Epidermal—typically lighter brown patches in the outer layer of the skin.
  • Dermal—usually grey in color; in the middle (dermis) layer of the skin.
  • Mixed—dark brown and occurring in both layers.

While notoriously difficult to eliminate, topical hydroquinone can typically begin to reduce these unsightly patches after 5 to 7 weeks of daily treatment, especially if other aggravating factors are eliminated or avoided. Your doctor will likely review your usage of any hormonal medication as well and advise continued sunscreen protection since ultraviolet rays can trigger reoccurrence.3

Combining hydroquinone with retinoids, glycolic acid, or steroids in a topical treatment may offer better results, as may using hydroquinone with intense pulsed-light therapy (for dermal or certain mixed type melasmas only).1

  1. Plensdorf, Scott and Martinez, Joy. American Family Physician Volume 79, Issue 2: Common Pigmentation Disorders. MD Consult: American Academy of Family Physicians. [Online] January 2009.
  2. American Academy of Dermatology. Melasma. American Academy of Dermatology Public Center. [Online] April 2009.
  3. Bandyopadhyay, Debabrata. Topical treatment of melasma. Indian Journal of Dermatology. [Online] 2009. DOI 10.4103/0019-5154.57602.;year=2009;volume=54;issue=4;spage=303;epage=309;aulast=Bandyopadhyay.
A relatively new procedure using intense bursts of light rather than lasers.
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