Melasma in Women With Darker Skin Tones: Here’s Why It’s Often Worse (With Images)

Melasma is a type of hyperpigmentation of the skin that causes brown discoloration on the face. It can happen in anyone, but there are certain risk factors that can make it more likely to occur. Melasma mostly affects women of color and currently has no cure. Although melasma isn’t dangerous, for some people it can have a huge psychological impact. 

Fortunately, there are ways to improve melasma and prevent it from coming back. Let’s take a closer look at why people with darker skin develop melasma and how they can get rid of it.

What are the symptoms of melasma?

Melasma’s only symptom is a change in skin color. It doesn’t cause any pain or itching. Melasma patches are: 

• Brown or bluish-gray

• Solid and/or freckled

• Often on the cheeks, forehead, nose, above the lip (but can involve the arms, necks, or elsewhere)

• Usually symmetric (on both sides of the face or body)

Pictures of melasma on dark skin

Here are some pictures of melasma on darker skin tones in different locations. 

Melasma on the cheek.

Melasma on the cheeks, nose, and chin.

Melasma above the lip.

Melasma on the forehead.

What causes melasma?

In melasma, pigment-producing cells called melanocytes make too much pigment (melanin). While the exact reason for this isn’t clear, genetics and certain environmental exposures seem to play a role. One big trigger is sun exposure. Melasma is most common in women of color living in sunny climates. It also runs in families — almost 50% of people with melasma have a family member with it. 

Why are women with darker skin tones at risk for melasma?

Women of color get melasma more commonly and more severely. The reason for this is the combination of darker skin and being female. Pigment-producing cells in darker skin tones make more pigment, so they’re more easily primed to make melanin. Women get melasma about nine times more often than men. This may be because pigment-producing cells are sensitive to the sex hormone estrogen, which plays an important role in female reproductive and sexual health. 

Risk factors for melasma

Different risk factors and triggers make it more likely to get melasma. If you have a family member with melasma, you’re more likely to get it. Other important triggers include:

• Sun exposure: The sun’s rays put pigment-producing cells into overdrive.

• Hormones: Estrogen, pregnancy hormones, thyroid imbalances, and birth control pills play a role in melasma.

• Medications: Medications that make your skin more sensitive to sunlight can aggravate melasma.

• Irritation from products: Inflammation can cause more hyperpigmentation.

• Blue light: High-energy visible blue light from our phones, computers, and tablets can contribute to hyperpigmentation.  

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How is melasma diagnosed on darker skin?

Most often, the diagnosis of melasma is clear based on your history and examination of your skin. Sometimes, your dermatologist might use a Wood’s lamp to look at your skin. This is a type of black light that can highlight the depth of pigment. In cases where the diagnosis isn’t obvious, you might need a small skin biopsy to differentiate melasma from other causes of hyperpigmentation.

How can people with darker skin treat melasma?

Melasma is notoriously hard to treat and has a tendency to recur. For best results, consider these steps:

1. Discontinue birth control pills if you’re on them. Consider switching to a nonhormonal type of birth control. There have been reports of women seeing their melasma clear after switching from birth control pills to an intrauterine device (IUD). 

2. Fine tune your skin care routine. For your skin care routine, use gentle, fragrance-free products and avoid scrubbing or rubbing. 

3. Protect your skin from sun and blue light. Avoid midday sun, wear a hat, and look for a mineral sunscreen that contains iron oxides. Mineral sunscreens protect you by sitting on your skin and reflecting ultraviolet rays. They are most often made of zinc oxide and/or titanium dioxide. Iron oxides are minerals found in tinted sunscreens. They protect your skin against high-energy visible blue light. 

4. See your dermatologist for treatment options. Most people will benefit from a combination of medications and procedures. 

Let’s review some common melasma therapies.

Hydroquinone 

Hydroquinone is an FDA-approved skin-lightening cream. It works by stopping the pigment-producing cells from making too much color. You apply it to darker areas to even the color. It’s best to use for short periods of time. Very rarely, using too much hydroquinone for too long can cause a side effect called ochronosis, where the skin darkens instead of lightens. Hydroquinone is available over the counter at a strength of 2% and by prescription at 4% or higher.

Tretinoin (Retin-A)

As a retinoid, tretinoin (Retin-A) is the topical form of vitamin A. It works for melasma by turning over the skin and exfoliating the extra pigment. It’s safer than hydroquinone for long-term use. 

Tri-luma 

Tri-luma is a cream that combines hydroquinone, a mild steroid, and tretinoin. It’s FDA approved for melasma. You can use it for up to 8 weeks. 

Cysteamine (Cyspera) 

Available in cream form, cysteamine works to lighten melasma about as well as hydroquinone. You can get it through specific doctor’s offices or online with a prescription. 

Azelaic acid

Azelaic acid is a topical medication that helps lower inflammation and can suppress pigment production in the skin. It’s often used to treat rosacea, but studies have shown that it can also help improve melasma and other types of hyperpigmentation. It’s also considered safe to use in pregnancy. Azelaic acid is available in different forms (like creams and gels) and in over-the-counter (OTC) and prescription strengths. 

Tranexamic acid 

When traditional treatment options don’t work, tranexamic acid (Cyklokapron, Lysteda) is an option. It’s available in pill form and can be compounded into a cream. So far, it’s “off label,” which means it’s not FDA approved for melasma.

In a study done in Singapore, about 90% of people who took tranexamic acid orally saw improvement in their melasma. They saw results within 2 months of starting treatment. There’s a risk of blood clots with this medication, so a healthcare professional will have to screen you for risk factors beforehand. 

Tranexamic acid in topical form also shows promise in melasma treatment. You can find it in OTC as well as in prescription compounds. 

Chemical peels

Chemical peels are agents applied to the skin that cause the top layers to peel or exfoliate. By shedding the top layers of skin, melasma pigment fades. Women of color can do many types of peels safely and effectively, but there are some things to be aware of: 

• There’s a risk of worsening melasma or causing hyperpigmentation, especially with deeper peels. 

• In some cases, hydroquinone is prescribed to use beforehand to prevent hyperpigmentation. 

• In all cases, strict sunscreen and sun avoidance will be important during the healing period. 

The best peel for melasma varies depending on your skin tone and the depth of your pigment. Most people will need to use peels along with medications for best results. 

Lasers

The use of lasers in melasma can be tricky. This is because the heat and inflammation can cause hyperpigmentation, especially in women of color. Various lasers are only safe for use in lighter skin types. In darker skin types, the laser that shows the most promise for melasma is nonablative fractional resurfacing. Specifically, several studies show that the thulium fiber 1927-nm laser is a safe and effective option for melasma on darker skin. 

Is melasma permanent?

Melasma can last for months to years. In some cases, it can be permanent. Even after successful treatment, it has a tendency to recur. For women who are pregnant, melasma might improve afterward as hormones normalize. 

To have success in the treatment of melasma, you’ll want to avoid triggers. This means:

• Avoiding the sun and using sunscreen when you’re outside

• Using gentle products that won’t cause irritation 

• Avoiding waxing the areas that are affected 

How can you prevent melasma on darker skin?

Proper sun protection is the key to success in the prevention of melasma. It’s important to wear a wide-brimmed hat while outside and apply sunscreen every day.

The best sunscreen to use is one that contains zinc oxide and/or titanium dioxide and SPF 30 or higher. These are mineral ingredients that physically block the sun’s rays from hitting the skin. There’s evidence that mineral sunscreens containing iron oxides (usually found in tinted sunscreens) work best to prevent hyperpigmentation in darker skin tones. 

Polypodium leucotomos is an antioxidant vitamin available over the counter that can help melasma by protecting skin from the effects of the sun’s rays. Keep in mind it’s always best to consult with a healthcare professional before starting any supplement.

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Written by:

Maryann Mikhail, MD

Maryann Mikhail, MD, is a board-certified dermatologist and medical writer based in South Florida. She is the founder of Waverly DermSpa in Fort Lauderdale and holds a voluntary faculty position at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami MIller School of Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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