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Medical Author:

Nili N. Alai, MD, FAAD

Nili N. Alai, MD, FAAD

Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is melasma? What are signs of melasma?
• What causes melasma?
• Where is melasma seen on the body?
• What are the types of melasma?
• How is melasma diagnosed?
• What is the treatment for melasma?
• What melasma treatments can I have at my doctor's office?
• Do lasers work for melasma?
• How does hydroquinone work in melasma?
• Are there non-hydroquinone alternative treatments for melasma?
• What is Tri-Luma?
• What SPF is recommended for melasma?
• Can melasma be prevented?
• What is the prognosis for melasma?
• Melasma At A Glance
• Patient Comments: Melasma - Causes
• Patient Comments: Melasma - Location on Body
• Find a local Dermatologist in your town
• Melasma Index

A daily sun protection factor (SPF) of at least 30 that contains physical blockers, such as zinc oxide and titanium dioxide, is recommended to block UV rays. Chemical blockers may not fully block both types of UV-A and UV-B as effectively as zinc or titanium. The regular use of sun protection enhances the effectiveness of melasma treatments.

Sometimes melasma may be preventable by avoiding facial sun exposure. In most cases, prevention is difficult. Individuals who have a family history of melasma must take extra precautions to prevent melasma. The most important way to prevent the onset of melasma and premature aging is to avoid the sun. If exposure to sunlight cannot be avoided, then hats, sunglasses, and sunblock with physical blockers should be worn.

Although melasma tends to be a chronic disorder with periodic ups and downs, the prognosis for most cases is good. Just as melasma develops slowly, clearance also tends to be slow. The gradual disappearance of dark spots is based on establishing the right treatment combination for each individual skin type. Melasma that does not successfully respond to treatment are because of a lack of avoidance of sun exposure.

• Melasma is most common in women 20-50 years of age.
• Melasma looks like brown, tan, or blue-gray spots on the face (hyperpigmentation).
• Melasma is characterized by three location patterns (central face, cheekbone, and jawline).
• Melasma is caused partly by sun, genetic predisposition, and hormonal changes.
• The most common treatment is topical creams containing hydroquinone.
• Melasma prevention requires sun avoidance and sun protection with hats and sunscreen.

REFERENCE:

Freedberg, Irwin M., et al. Fitzpatrick's Dermatology in General Medicine. 4th ed. Vol. 1. New York: McGraw-Hill, 1993.