Brown patches across the cheeks, forehead, upper lip or other areas of the face can easily be mistaken for ordinary sun damage or hyperpigmentation. But sometimes those patches are a condition called melasma.
Melasma is a common pigmentation disorder that causes patches of skin to become darker than the surrounding complexion. It most frequently appears on the face and is especially common in women. Hormonal changes, sunlight, visible light and other factors can contribute to its development.
One of the most important things to understand about melasma is that not every dark spot is melasma, and not every pigmentation treatment is appropriate for melasma.
At Agnes Beauty & Wellness in Huntington Beach, Agnes works with a variety of skin concerns and frequently discusses pigmentation as part of professional skin care and facial massage. Agnes does not medically diagnose or medically treat melasma. She does, however, use facial massage techniques such as Gua Sha that she has found beneficial for the appearance of pigmentation. Clients seeking medical diagnosis or treatment of melasma should consult a dermatologist or other appropriately qualified medical provider.
What Is Melasma?
Melasma is an acquired pigmentation condition that typically produces symmetrical brown, tan, gray-brown or sometimes bluish-gray patches on the skin.
It most commonly appears on areas of the face including:
- Cheeks
- Forehead
- Upper lip
- Bridge of the nose
- Chin
- Jawline
Less commonly, pigmentation can develop on areas such as the neck or arms.
Melasma is sometimes called the “mask of pregnancy” because hormonal changes associated with pregnancy can trigger the condition. However, you do not have to be pregnant to develop melasma, and men can develop it as well.
Melasma is not contagious, and it is not skin cancer. It is primarily a pigmentation disorder, although it can be persistent and difficult to manage.
For additional medical information about the condition, see the American Academy of Dermatology’s overview of melasma.
What Does Melasma Look Like?
People often search for melasma without knowing the name of the condition. You might instead be wondering:
- Why am I suddenly getting brown patches on my cheeks?
- Why is the skin above my upper lip getting darker?
- Why do I have matching dark patches on both sides of my face?
- Why does my pigmentation get darker during the summer?
- Are these sun spots or melasma?
- Why did dark patches appear during pregnancy?
- What are these brown or gray patches appearing on my face?
These symptoms do not automatically mean that you have melasma. Several types of pigmentation can look similar, including sun spots and post-inflammatory hyperpigmentation.
If you are primarily experiencing isolated dark spots, discoloration following acne or uneven pigmentation, read our guide to hyperpigmentation and dark spots.
Melasma vs. Hyperpigmentation: What Is the Difference?
Hyperpigmentation is a broad term describing skin that has become darker than the surrounding area. Melasma is one specific type of hyperpigmentation.
Other forms of hyperpigmentation can include sun spots and post-inflammatory pigmentation that remains after acne, irritation or inflammation.
This distinction matters because treatments that may be appropriate for some ordinary dark spots are not automatically appropriate for melasma.
Melasma tends to have a more complex relationship with hormones, ultraviolet radiation and visible light, and it can recur after apparently successful treatment.
What Causes Melasma?
Melasma develops when pigment-producing cells in the skin become more active and produce excess melanin. Usually there is not one single cause. Instead, several triggers and predispositions can interact.
Sun Exposure
Sunlight is one of the most important melasma triggers. Ultraviolet exposure stimulates pigment production and can make existing melasma darker.
This is also why someone may notice that their pigmentation becomes more visible during summer and fades somewhat during winter.
Visible Light
Ultraviolet radiation is not the entire story. Visible light can also contribute to melasma, particularly in people with darker skin tones.
For this reason, dermatologists may recommend tinted sunscreen containing iron oxides in addition to broad-spectrum UV protection.
Pregnancy and Hormonal Changes
Melasma frequently appears during pregnancy, which explains the older term “mask of pregnancy.”
Changes in hormones are believed to influence pigmentation in people who are susceptible to the condition.
Hormonal Birth Control
Hormonal contraceptives can also be associated with melasma in some people. If you believe medication or hormonal contraception may be contributing to your pigmentation, discuss it with the healthcare professional who prescribed it rather than discontinuing medication yourself.
Genetics and Skin Type
Genetic susceptibility also matters. Melasma is more common among people who tan easily and people with medium to darker skin tones, although it can occur across different skin types.
Is Melasma Permanent?
Not necessarily.
Melasma associated with a temporary hormonal trigger such as pregnancy may fade after the trigger changes. For other people, however, melasma can persist for years or repeatedly return.
That is why melasma is generally approached as a condition that requires long-term management and prevention of triggers, rather than something that can always be permanently removed with one treatment.
How Is Melasma Treated?
There is no single treatment that works for everyone. A dermatologist may develop a treatment plan according to the person's skin type, pigmentation depth, triggers, medical history and previous response to treatment.
Medical treatment commonly combines rigorous sun protection with topical medications and, when appropriate, carefully selected procedures.
Hydroquinone
Hydroquinone is one of the best-known topical medications used for melasma. It works by reducing the production of excess pigment.
Higher-strength or prescription hydroquinone should be used under appropriate medical guidance rather than assuming that stronger or longer use will necessarily produce better results.
Tretinoin and Combination Therapy
Dermatologists may prescribe tretinoin in combination with other medications.
One established approach is a prescription triple-combination cream containing hydroquinone, tretinoin and a corticosteroid.
Azelaic Acid, Kojic Acid and Vitamin C
Other topical ingredients may be incorporated into a pigmentation treatment plan, including azelaic acid, kojic acid and vitamin C.
Which ingredients are appropriate depends on the individual and should not be determined solely by how dark the pigmentation appears.
Tranexamic Acid
Tranexamic acid has also been used by dermatologists for difficult melasma. It may be used topically or, in selected cases, orally.
Oral tranexamic acid is not appropriate for everyone and requires medical evaluation because it can carry important risks, including concerns involving blood clotting.
Chemical Peels
Certain chemical peels may sometimes be incorporated into dermatologist-directed melasma management.
However, aggressive treatment is not necessarily better. Irritating or injuring the skin can potentially worsen pigmentation, particularly in skin that is susceptible to post-inflammatory hyperpigmentation.
Microneedling, Lasers and Light-Based Procedures
Dermatologists may sometimes use procedures such as microneedling or selected laser and light treatments as part of a larger treatment plan.
These procedures require careful patient selection. Melasma can sometimes become worse following inappropriate or overly aggressive treatment, which is another reason professional diagnosis matters.
For more information about dermatologist-directed treatment options, see the American Academy of Dermatology’s melasma treatment guide.
Why Sunscreen Is One of the Most Important Parts of Melasma Management
You can spend considerable time and money trying to fade pigmentation while simultaneously allowing sunlight to stimulate more pigment production.
That is why daily photoprotection is central to melasma management.
The American Academy of Dermatology recommends broad-spectrum sunscreen with an SPF of at least 30. For people with melasma, tinted sunscreen containing iron oxide can provide additional protection against visible light.
Other protective measures include:
- Wearing a wide-brimmed hat outdoors
- Seeking shade when possible
- Avoiding tanning beds and sunlamps
- Reapplying sunscreen during extended outdoor exposure
- Using sun-protective clothing
Sun protection remains important even after pigmentation improves because melasma can return.
Can You Prevent Melasma?
There is no guaranteed way to prevent melasma because genetics and hormonal influences cannot always be controlled. However, reducing known triggers can help decrease the likelihood of worsening pigmentation.
A prevention strategy should begin with consistent sun protection rather than waiting until dark patches become noticeable.
Gentle skin care is also important. Products that repeatedly burn, sting or inflame the skin can contribute to pigmentation problems. More aggressive does not always mean more effective when dealing with pigment-prone skin.
Can Gua Sha Help With Melasma and Pigmentation?
Agnes has specifically discussed the relationship between Gua Sha facial massage, pigmentation and melasma in her educational videos.
During Gua Sha treatment, Agnes uses controlled movements with a smooth-edged tool across the face. The technique is intended to stimulate circulation, encourage lymphatic movement, reduce facial tension and support the overall appearance of the skin.
When discussing pigmentation in her Gua Sha video, Agnes explains that the treatment can help “disperse” the appearance of pigmentation and specifically notes that, in her experience, Gua Sha can be particularly helpful for skin affected by melasma.
This is an important distinction: Agnes is describing her professional experience with Gua Sha and how the skin can appear following facial massage. Gua Sha is not currently considered a medically established treatment for melasma, and it should not replace dermatologist-directed care for the condition.
Melasma is complex because pigment production can be influenced by hormones, ultraviolet radiation, visible light and individual susceptibility. Medical treatment may therefore involve strict sun protection, prescription topical medications and, in selected cases, dermatologist-directed procedures.
Gua Sha can instead be viewed as a complementary facial massage technique. Agnes uses Gua Sha to support circulation, lymphatic movement, facial sculpting and overall skin appearance, while clients seeking medical treatment for melasma should also seek appropriate medical guidance.
Watch Agnes Explain Gua Sha, Pigmentation and Melasma
In the video below, Agnes discusses Gua Sha facial massage and explains why, based on her professional experience, she believes the technique can be beneficial for the appearance of pigmentation and melasma.
For a deeper explanation of the facial massage technique itself, read What Is Gua Sha? Facial Massage, Benefits & How It Works.
Can Facials Get Rid of Melasma?
This is where it is particularly important to distinguish melasma from other forms of pigmentation.
A facial may improve hydration, exfoliation, texture or the overall appearance of the complexion, depending on the treatment. That does not necessarily mean the facial is treating the biological mechanisms responsible for melasma.
Agnes Beauty & Wellness does not provide medical diagnosis or medical treatment of melasma. Agnes does use facial massage techniques, including Gua Sha, that she has found beneficial for the appearance of pigmentation.
If pigmentation appears to be melasma rather than ordinary sun damage, post-acne pigmentation or another cosmetic skin concern, evaluation by a dermatologist or qualified medical provider can help determine what is actually causing it and which treatments are appropriate.
Melasma vs. Post-Acne Dark Spots
These two concerns are frequently confused.
A brown spot remaining where a pimple recently healed may be post-inflammatory hyperpigmentation (PIH). Melasma, by comparison, commonly produces broader patches and may appear symmetrically across areas such as both cheeks, the forehead or upper lip.
The underlying causes are different, which means the treatment strategy can also be different.
If your discoloration developed following acne, you may want to read our guide to acne and professional acne care and our detailed article about dark spots and hyperpigmentation.
When Should You See a Dermatologist?
Consider seeing a dermatologist when you develop unexplained facial pigmentation, especially if:
- The pigmentation is spreading or becoming darker
- Dark patches appear symmetrically across your face
- You developed pigmentation during pregnancy or after hormonal changes
- You are unsure whether the discoloration is melasma, sun damage or another condition
- Over-the-counter pigmentation products are not helping
- A dark spot changes in an unusual way
A dermatologist can evaluate the pigmentation and determine whether it is consistent with melasma or another skin condition.
What If My Pigmentation Isn't Melasma?
This is an important question because not all facial pigmentation is melasma.
Dark spots may develop following acne and inflammation, from accumulated sun exposure or for other reasons. These concerns can require a very different approach from melasma.
Agnes works with other skin concerns that can contribute to an uneven-looking complexion, including certain forms of hyperpigmentation and post-acne discoloration.
Depending on the condition of your skin and the cause of the pigmentation, an appropriate professional skin-care plan may include treatments such as DMK Enzyme Therapy, professional exfoliation, dermaplaning or other customized facial treatments.
The goal is not to label every brown spot as the same condition. The first question should be: Why did the pigmentation develop?
If your concern is ordinary dark spots, post-acne marks, sun-related pigmentation or uneven skin tone rather than diagnosed melasma, start with our complete guide to hyperpigmentation and dark spots.
Frequently Asked Questions About Melasma
What is the main cause of melasma?
There usually isn't one single cause. Melasma is associated with a combination of genetic susceptibility, sunlight, visible light and hormonal influences. Pregnancy and hormonal contraception are well-known triggers in susceptible people.
Does melasma go away?
Sometimes. Melasma triggered by pregnancy or another temporary hormonal change may fade, while other cases can persist for years or repeatedly return.
Can sunscreen improve melasma?
Sun protection is a fundamental part of melasma management because sunlight can stimulate pigment production. Dermatologists commonly recommend broad-spectrum SPF 30 or higher, and tinted sunscreen containing iron oxide may provide additional protection against visible light.
Is melasma the same as hyperpigmentation?
Melasma is a type of hyperpigmentation, but not all hyperpigmentation is melasma. Acne marks, sun spots and post-inflammatory pigmentation have different causes and may require different treatment approaches.
Can Gua Sha remove melasma?
Gua Sha should not be described as a proven medical treatment that removes melasma. Agnes has found Gua Sha beneficial for the appearance of pigmentation and explains in her video that the technique can help “disperse” the appearance of pigmentation. Medical melasma management, however, should be discussed with a dermatologist or appropriately qualified healthcare provider.
Does Agnes Beauty & Wellness treat melasma?
Agnes Beauty & Wellness does not medically diagnose or medically treat melasma. Agnes does use facial massage techniques such as Gua Sha that, based on her professional experience, she has found beneficial for the appearance of pigmentation. Clients seeking medical melasma treatment should consult a dermatologist.
What if my dark spots are not melasma?
There are many other causes of facial pigmentation. If you are dealing with post-acne marks, sun-related pigmentation or uneven skin tone, read our guide to hyperpigmentation and dark spots to learn more about those concerns and professional skin-care options.
Understanding Your Pigmentation Is the First Step
Melasma, sun spots, post-acne marks and other forms of hyperpigmentation can look similar, but they do not necessarily have the same causes or respond to the same treatments.
If broad or symmetrical patches of pigmentation appear on your face, particularly following hormonal changes or pregnancy, consider having the condition evaluated by a dermatologist. If your concern involves other forms of uneven pigmentation, acne-related discoloration or overall skin health, Agnes can help you explore professional skin-care options appropriate for your individual concerns.
To learn more about Agnes and the advanced skin and facial massage treatments available in Huntington Beach, visit Agnes Beauty & Wellness.
About Agnes Beauty & Wellness
Agnes Beauty & Wellness is a skin care and facial massage studio in Huntington Beach, California. Agnes Grumslys is a California Licensed Cosmetologist (#A330955) specializing in advanced facial treatments, DMK Enzyme Therapy, facial sculpting, lymphatic techniques and professional skin care.
This article is provided for educational purposes and is not intended to diagnose or medically treat melasma or another medical condition. Unexplained or changing skin pigmentation should be evaluated by an appropriately qualified healthcare professional.