If melasma appears while on birth control pills or during pregnancy, the discoloration will generally resolve itself in a couple of months after resolution of these high estrogen states. While melasma does not pose any acute health risks, women affected by the discoloration usually voice various cosmetic concerns about the condition, especially when it appears as two symmetrical brown splotches on the cheeks and upper lip.
The skin’s pigment-making cells, called melanocytes, are simulated by estrogen to make more melanin when exposed to the sun’s ultraviolet rays.
Melasma is generally diagnosed by a dermatologist on exam, but a lamp that emits ultraviolet rays, called a Wood’s light, can be helpful in determining how far the discoloration has penetrated into the skin. A skin biopsy can also be performed to see if the discoloration has developed because of some other disorder.
In certain cases, melasma will go away without any treatment. For more persistent cases, though, over-the-counter creams with azelaic or kojic acid can be prescribed to lighten the affected area. Other treatment options include taking medication with tretinoin and corticosteroids in it. The most common treatment option for melasma, however, is hydroquinone, which can be applied directly to the skin. It works by gradually lightening the discolored areas. Using sunscreen and wearing a wide-brimmed hat are the most effective ways to prevent melasma from recurring.
The most effective instruments we have for treating melasma are chemical peels and laser light.