What Is Melasma? Understanding Hyperpigmentation Patches

If you've noticed brown or gray patches appearing symmetrically on your face, particularly on your cheeks, forehead, or above your upper lip, you might have melasma. This common skin condition affects over 5 million people in the United States, with women making up about 90% of cases. Understanding what causes these patches and how melasma differs from other types of dark spots can help you manage this frustrating condition.

What Is Melasma?

Melasma is a type of hyperpigmentation that causes irregular patches of brown, gray-brown, or blue-gray discoloration on the skin. Unlike other forms of dark spots, melasma typically appears symmetrically on both sides of the face in sun-exposed areas. The most common locations include the cheeks, bridge of the nose, forehead, chin, and upper lip.

While less common, melasma can also appear on the arms, neck, and back when these areas get regular sun exposure.

Melasma vs. Chloasma: Are They the Same?

Melasma and chloasma refer to the same condition. The terms are used interchangeably in medical practice, though "melasma" has become the preferred term. Some doctors use "chloasma" specifically when referring to pregnancy-related melasma, often called the "mask of pregnancy." Both terms describe the exact same pattern of facial hyperpigmentation.

What Causes Melasma?

Melasma results from a combination of factors working together:

Sun exposure: Ultraviolet light triggers increased melanin production in the skin. Even visible light from screens and indoor lighting can worsen melasma.

Hormones: Changes in estrogen and progesterone levels stimulate melanin-producing cells. This is why melasma often develops during pregnancy, with birth control use, or during hormone replacement therapy.

Genetics: Melasma tends to run in families, suggesting a hereditary component.

Research shows that hormones and sun exposure work together rather than causing melasma independently. The hormones make your skin more sensitive to light, which then triggers the pigmentation.

Who Gets Melasma?

Melasma affects about 1% of the general population, but certain groups have higher rates:

Women, especially those between ages 20-40

People with medium to dark skin tones (Fitzpatrick skin types III-V)

Latino and Asian populations (rates of 8.8-40% in some communities)

Pregnant women or those taking hormonal medications

People living in areas with intense sun exposure

Melasma vs. Other Types of Hyperpigmentation

Unlike post-inflammatory hyperpigmentation (PIH), which appears after skin injury or inflammation like acne, melasma develops without any preceding trauma. PIH appears irregularly in spots where inflammation occurred, while melasma creates symmetrical patches on both sides of the face.

Age spots or sun spots typically appear as individual dark spots on sun-exposed areas in older adults. Melasma, by contrast, forms larger, interconnected patches and often affects younger women.

When to See a Dermatologist

If you notice new patches of discoloration on your face, see a dermatologist for proper diagnosis. While melasma is harmless, it can be mistaken for other conditions that require different treatment approaches. A dermatologist can examine your skin and create a treatment plan tailored to your skin type and the depth of pigmentation. Early intervention often leads to better results, especially with consistent sun protection and appropriate treatments.