Melasma (chloasma, pigment spots)

What is melasma?

Melasma (also known as chloasma) is a harmless hyperpigmentation of the skin. Melasma occurs when the skin produces more melanin than usual in one or more areas. The result is large brown or gray-brown pigment spots. Melasma often occurs in areas that are exposed to the sun, i.e. the cheeks, forehead, upper lip and chin. These hyperpigmentations occur mainly in women, especially during pregnancy (so-called pregnancy mask), when taking hormonal contraceptives or due to UV radiation. Melasma does not usually cause any further symptoms.

What types of melasma (pigment spots) are there?

Melasma is divided into three main forms depending on the depth of pigment deposition in the skin:

Epidermal melasma

• The pigment deposit is located in the uppermost layer of the skin (epidermis).
• The spots are sharply defined, brown in color and usually respond well to treatment with lightening creams.

Dermal melasma

• The pigments are located in the deeper layer of the skin (dermis).
• The spots appear gray or bluish and are less sharply defined.
• This form is more difficult to treat, as the deeper pigments are broken down more slowly.

Mixed type melasma

• Combination of epidermal and dermal melasma.
• Both brown and gray patches appear.
• Treatment is often more difficult as both superficial and deeper pigments are affected.

Melasma: causes and risk factors for pigment spots

The exact causes of melasma are not yet fully understood. Several factors seem to play a role:

• Female gender: Women are significantly more frequently affected than men.
• Darker skin type (Fitzpatrick III-V): Higher melanin production favors melasma.
• Melasma due to sun damage: Sunlight/UV radiation stimulates melanin production and can increase the formation of melasma.
• Melasma caused by hormones: Melasma can occur particularly during pregnancy, when taking the contraceptive pill or as a result of hormonal changes during the menopause.
• Genetics: A familial clustering of melasma indicates a genetic predisposition.
• Certain cosmetics and skin irritations: Aggressive products or fragrances can increase melasma.
• Medication: Hormonal contraceptives, certain anti-epileptic drugs or medication may make the skin more sensitive to light.
• Heat and infrared radiation: Heat sources such as saunas or hot environments can also increase melasma.
• Chronic inflammation of the skin: for example due to incorrect skin care or skin diseases.

How does melasma develop?

Melasma is caused by excessive production of melanin, the pigment that gives the skin its color. Special cells, the so-called melanocytes, are responsible for this. UV radiation, hormonal changes or other stimuli cause these cells to become overactive.

Normally the melanin is evenly distributed and ensures uniform pigmentation. In melasma, the melanocytes in certain areas of the skin produce too much melanin. This excess pigment collects in patches in the uppermost layer of the skin (epidermal melasma) or deeper in the dermis (dermal melasma). This leads to the typical brown to gray-brown skin discoloration.

Important: The skin spots usually do not disappear by themselves and can worsen due to further sun exposure or hormonal changes.

Why are melasma marks so persistent?

Our skin has a memory. Once overactive, melanocytes tend to produce excess melanin again and again. The consequence: without protection from UV radiation, melasma can worsen or reappear even after successful treatment.

Symptoms Melasma: signs and warning signals of hyperpigmentation

Melasma is a symmetrical, patchy pigment change that mainly occurs on the face. They are not raised and not painful, but can be cosmetically disturbing.

Typical melasma symptoms are

• brown to gray-brown patches with different shades depending on the depth of pigmentation
• Sharp or blurred hyperpigmentation, which can look different depending on the skin type
• Melasma usually occurs evenly on both sides of the face.
• The spots appear without swelling, pain, itching or other symptoms of inflammation.

Frequently affected skin areas are:

• Face: especially forehead, cheeks, upper lip, chin and bridge of the nose.
• Neck and décolleté: Rarely, but possible, especially with high UV exposure.
• Forearms: Rarely and only in intense sunlight.

Melasma: diagnosis and examinations of pigment disorders

Melasma is usually diagnosed by visual diagnosis and a clinical examination of the skin. Your dermatologist will assess the distribution, color and depth of the pigment disorder. In rare cases, a skin biopsy may be necessary to rule out other skin diseases. A comprehensive medical history about possible triggers such as hormonal changes, medication or sun exposure is also important in order to identify the causes and develop an individual therapy.

Melasma: prevention, early detection, prognosis for pigment spots

How can I prevent melasma?

You can prevent melasma or at least reduce its severity by taking targeted measures. The most important protection is the consistent use of sunscreen with a high sun protection factor (50+), as UV rays stimulate melanin production and intensify existing pigmentation spots. In addition, those affected should avoid direct sunlight and wear protective clothing such as hats or sunglasses. Hormonal influences also play an important role, so it may be useful to talk to your doctor about alternative contraceptive methods or hormone-free options. Gentle skin care with brightening and anti-inflammatory active ingredients such as vitamin C, niacinamide or azelaic acid helps to strengthen the skin barrier and prevent hyperpigmentation. It is better to avoid aggressive cosmetics or treatments that irritate the skin and additionally stimulate melanin production.

Melasma early detection

Early detection of melasma is crucial. This prevents hyperpigmentation from worsening. And your doctor can take appropriate measures in good time. People with a genetic predisposition, hormonal changes or high UV exposure should pay particular attention to changes in their skin. Regular self-checks and early skin examinations help to detect melasma at an early stage.

Melasma prognosis

The prognosis of melasma varies from person to person and depends on various factors: The cause, the depth of the pigmentation and the treatment. As it is a chronic pigment disorder, melasma can often persist for years or reappear if the skin is re-exposed to triggering factors such as UV radiation or hormonal changes.

Superficial forms of melasma usually respond well to lightening creams, chemical peels or laser therapies. Deeper pigmentation is more difficult to treat. Consistent skin care with sun protection, skin-lightening and anti-inflammatory active ingredients can help to improve the appearance of the skin in the long term.

Even if melasma is not dangerous, many sufferers find the discoloration cosmetically unpleasant. With the right therapy and lifestyle, you can often significantly reduce melasma and in many cases even bring it under control.

Melasma treatment: What helps with pigment spots?

Which measures are appropriate for melasma depends largely on the cause. If the discoloration is caused by hormones, it can often disappear on its own. However, melasma often remains permanent. In these cases, dermatological treatment can help to specifically reduce or remove the skin discoloration. Melasma can also be covered well with camouflage make-up.

Here are some treatment options to help remove or reduce melasma:

Sun protection is particularly important for melasma

• Consistent sun protection: The most important step in the treatment of melasma is protection from the sun. UV radiation promotes pigment formation. Use a broad-spectrum sunscreen, ideally with sun protection factor 50, every day and apply it generously, even on cloudy days.
• Headgear and protective clothing: In addition to sunscreen, it is a good idea to wear a hat and long clothing or stay in the shade.

Topical treatments for skin lightening with melasma

• Hydroquinone: A commonly used bleaching agent that inhibits melanin production. It is available in over-the-counter and prescription products.
• Retinoids: Products such as tretinoin promote skin renewal and can help to improve skin texture and reduce pigmentation spots.
• Vitamin C: This antioxidant stimulates skin renewal, helps to brighten the complexion and can protect the skin from further UV damage.
• Azelaic acid: Helps to reduce pigmentation spots and has anti-inflammatory properties.
• Kojic acid: Another ingredient that can slow down melanin production and lighten the skin.

Chemical peels for melasma

• AHAs (alpha hydroxy acids) and other chemical peels can help to remove the top layers of skin and reduce pigmentation spots. As a rule, several sessions are required to achieve a visible result.

Laser treatments for melasma

• During laser therapy, the pigment accumulations of melasma in the skin are broken down in a targeted manner. This allows the body to gradually break them down and remove them via the lymphatic system. Various lasers are available.
• Q-switched Nd:YAG laser: A laser that is often used to treat hyperpigmentation.
• Fraxel laser: This laser penetrates deep into the skin and can help to reduce pigmentation spots.

Microdermabrasion for melasma

• This is a gentle method in which the top layer of skin is removed in order to improve the skin structure and minimize pigmentation spots.

How long does it take for melasma to disappear?

Melasma can persist for many months or years and treatment requires patience. It is important to continue treatment consistently, even if success is not immediate.

Our dermatologists are able to professionally reduce or remove unwanted skin changes. At the same time, we specialize in detecting potentially dangerous skin changes such as skin tumours at an early stage and initiating the necessary treatments. We also provide you with comprehensive information about the effects and possible side effects of aesthetic treatments.