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Melasma

Melasma (chloasma) · Melasma (chloasma)

What it is

Hormones and sunlight drive pigment cells to make brown patches on the face — common in pregnancy and on the pill.

Symptoms & signs

  • Symmetrical brown patches on the cheeks, forehead and upper lip
  • darkens in summer
  • no itch or pain

🚩 Get help if…

  • see a doctor soon A single dark patch that grows, bleeds or changes shape
  • see a doctor soon Patches with uneven colour or edges
  • see a doctor soon Dark patches with tiredness, weight loss or low blood pressure
  • see a doctor soon Patches spreading to areas without sun exposure

Where it strikes

Medical treatment

  • Daily broad-spectrum SPF 50 with iron oxides (tinted)
  • hydroquinone 4% or triple cream (Kligman)
  • azelaic acid
  • oral tranexamic acid
  • chemical peels

Natural & lifestyle

  • Hats and shade
  • stop hormonal contraception if possible
  • avoid harsh scrubs and heat

Emerging & experimental

  • Topical tranexamic acid and cysteamine
  • low-energy picosecond laser
  • thiamidol

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Niacinamide cream — small trials lighten patches early / small studies
  • Polypodium leucotomos extract by mouth — small trials as an add-on to sun protection early / small studies
  • Lemon juice on the skin — can burn and darken skin in sunlight anecdotal / traditional
  • Mercury-containing 'skin-lightening' creams — banned; they damage the kidneys anecdotal / traditional

ICD codes