Do You Know What Really Causes Melasma?

In your reproductive years, it’s not uncommon to experience all sorts of changes to your body and skin. So if you’ve recently noticed patchy brown, tan, or blue-gray facial skin discoloration, you may be experiencing what is known as “the mask of pregnancy,” or melasma. This skin condition is one of the harder types of hyperpigmentation to correct because it is tied to estrogen and progesterone (found in birth control pills) and can affect the deep dermal layers of the skin. Learn more about what’s causing your melasma below.

How Severe is Your Melasma?

One of the easiest ways to determine how deep your melasma goes is by stretching the skin. “If you stretch out the discolored portion and it appears lighter than when the skin is at rest, then the hyperpigmentation is superficial,” says Beverly Hills, CA, dermatologist Zein E. Obagi, MD. “If it’s darker, then the pigmentation lies in the dermal layers.”

The Role of Estrogen

Hormones play a big role in how hyperpigmentation affects the skin, especially estrogen. “When estrogen levels are elevated, either from pregnancy or birth control pills, additional melanin is produced,” says Dr. Obagi. “With all this extra melanin floating in the skin, it settles as dark deposits, which results in melasma.” Some who experience hormone-induced hyperpigmentation, which can also be caused by progesterone, notice that the discoloration ends once hormone levels stabilize; others need medical treatment to even out their skin.

What it Looks Like

Melasma appears as dark patches on the skin. “You usually find it on the sides of the face, the forehead, the upper lip, the chin and the sides of the neck,” says New York City dermatologist Doris Day, MD. Mild melasma appears as faint brown splotches that are rather small, but full-blown melasma surfaces as patches of light brown skin with irregular borders.

Why it Occurs

The true cause of melasma is still not known, but most experts agree that it is triggered by excess melanocytes, which produce too much pigment in the skin. “Estrogen is at the heart of the problem but the sun is a catalyst too,” says Reston, VA, dermatologist Dr. Syed Amiry. “The combination of the two causes unwanted pigment to be produced, resulting in dark patches because of an imbalance of pigment in certain areas.” Melasma can occur at either the surface level (superficial melasma) or in the deeper layers of skin (dermal or deep melasma), giving it more of a spread-out appearance. “Melasma is more apparent during and after periods of sun exposure and less obvious in the winter months,” says Dr. Day. Although melasma is not hereditary, there is some genetic tie to it.

Who it Affects

Melasma mostly affects pregnant women, but you don’t have to be pregnant or have had a child to experience it. “In pregnancy, melasma usually appears in the second or third trimester,” says New York City dermatologist Doris Day, MD. It’s also more common in those with dark skin tones, like Hispanics and Asians.