“What Causes Melasma on My Face?” – one of the most common talked of many individuals. Melasma on the face appears in both men and women when melanocytes (the pigment-producing cells in your skin) become overactive and produce excess melanin, the pigment responsible for your skin colour. They result as brown, grey-brown, or darker patches on the skin. The most common causes are sunlight and visible light, hormonal changes (pregnancy, birth control pills, hormone therapy), heat, some medicines and skin products, and skin irritation. Usually two or three causes work together. Melasma is not an infection, it is not contagious, and it is not skin cancer.

What Is Melasma?

Melasma (মেছতা), also called chloasma, is a common skin condition that causes brown or grey-brown patches, usually on the face, including the cheeks, forehead, nose, and upper lip.. The patches are flat and painless, and they usually look the same on both sides, a little like a mask. The patches are typically symmetrical, which helps distinguish melasma from other pigment disorders. 

It most often starts between the ages of 20 and 40 especially during pregnancy, and it is more common in people with naturally brown skin, as is the case for many people in Bangladesh Melasma is one type of hyperpigmentation that makes the skin darker in patches. To see how it differs from other dark marks, read our guide to freckles. For personalized treatment options, read our guide on melasma laser treatment.

At SUO XI Hospital (Skin Care), we understand the emotional impact of skin concerns like melasma and offer advanced, personalised melasma treatment in Bangladesh to restore your skin’s natural radiance. 

How Does Melasma Develop on the Face? Predisposition and Triggers

Melasma develops when your skin produces too much melanin (the pigment that gives your skin its colour). Two main factors contribute to this condition:

• Predisposition: Some people naturally have a higher chance of developing melasma because of their genes or family history.
• Triggers: Certain factors, such as sunlight, hormonal changes and heat, can trigger melasma or make existing dark patches worse.

Cause or trigger	How does it contribute to the formation of melasma?	Can you change it?
Sun and UV light	Stimulates melanin production; tanning beds are stronger than sunlight	Yes, with protection
Visible light	Blue-violet light from the sun, bulbs and screens can darken melasma	Partly
Heat	Listed as an environmental trigger.	Partly
Hormones	Estrogen and progesterone from pregnancy, pills, implants, IUDs or hormone therapy	Sometimes, needs  doctor consultation
Genetics	About 48% of 324 patients in one global study had an affected relative	No
Medicines	Anti-seizure drugs, birth control pills and some photosensitising drugs	Needs Doctor Consultation
Products	Perfumed soaps and cosmetics may cause phototoxic reactions	Yes
Skin irritation	Inflammation and a damaged skin barrier are linked to pigmentation	Yes
Thyroid disease	Associated with melasma (does not directly cause melasma)	Needs Doctor Consultation before treatment

What Causes Melasma and What Makes It Worse?

Sun Exposure

Melasma can be caused by sun exposure (when skin is in direct contact with the sun, including skin on the face, neck and arms) and can darken the pigment in existing patches of melasma, as the sun stimulates the skin to make more pigment. UV rays and visible light can both cause pigmentation, especially in those who are prone to melasma.. Here’s how it actually happens:

1. Sunlight reaches the skin: Sunlight contains UVA rays, UVB rays and visible light. These can have an impact on pigment production in the skin.
2. Melanocytes, which produce melanin become more active: Light stimulates the production of melanin by the pigment producing cells known as melanocytes. Skin colour is due to melanin.
3. Excess pigment becomes visible: Melanocytes in people with melasma are more active. The appearance of brown or grey-brown patches is often seen in certain areas due to the increase in melanin, particularly on sun-exposed areas of the face.
4. Existing Patches may appear darker: If they already exist, they could appear darker with additional UV exposure, or they may begin to show again after having faded. Too much exposure to visible light can also make melasma worse, particularly for individuals with darker complexions. 

While melasma often improves in winter, it worsens in summer or during other periods of intense sun exposure. 

Sunlight is an important trigger, but it is not the only factor. Hormonal changes and family history may also contribute, and the combination of factors varies from person to person. Let’s dive into it more..

Hormonal Factors

The formation of melasma on the face is greatly contributed by hormonal changes, particularly in women. Hormonal changes could be responsible for melasma, because it affects melanocytes, the skin cells that create melanin. In some individuals, pregnancy, hormonal birth control or hormone replacement therapy can cause excess pigment production and darker patches on the face.

How hormones could be playing a role:

1. Hormone levels change: The levels of hormones like estrogen and progesterone increase during pregnancy. Another way to alter a person’s hormonal exposure includes the use of hormonal contraceptives or hormone therapy.
   
2. Brown or grey-brown patches appear: Excess melanin in some areas of the skin makes them darker and can form brown or grey-brown patches. Exposure to the sun and genetics can also contribute to the appearance or worsening of melasma.
   
3. Darker patches become visible: Excess melanin in certain areas of the skin can appear as brown or grey-brown patches. Sun exposure and genetic tendency may also play a role in whether melasma develops or becomes more noticeable.

Melasma that appears during pregnancy may fade after childbirth, although it can persist. Having melasma does not necessarily mean that a person has a hormonal imbalance. 

Genetics

One of the strongest risk factors to the causes of melasma is family history. A global study of 324 patients has found 48% had a family member with melasma. According to DermNet, approximately 60% of patients state that they have a family member with the condition. The risk is also increased by having medium to dark skin (Fitzpatrick type III to V). That’s why two people who experience the same amount of sunlight can experience very different results. 

Medication and Products

Some drugs and cosmetics may exacerbate hyper pigmentation or cause it. Some people, for instance, may develop melasma due to hormonal birth control or hormone replacement therapy.

Other products, such as irritating products, may also cause darkening, as well as other medications (some blood pressure medications, some blood pressure products, some antibiotics) and scented products (some retinoids) that react with the sun. Not all of these dark patches are melasma, however, and some can be due to irritation or product reaction, and therefore are referred to as post-inflammatory hyperpigmentation.

Do not self-discontinue a prescribed medication. If you think any medicine may be having an impact on your skin, consult your doctor about the risks and benefits of continuing the medication. 

Heat and Visible Light

Sunlight (visible light) may stimulate the production of melanin and darken melasma, while heat can be a factor that leads to more pigmentation in certain individuals. There is more evidence supporting visible light, and studies are ongoing to determine the relative contributions of heat to melasma. 

• Visible light: Visible light, particularly the blue-violet light in the 420 – 470nm range, is involved in the process of melasma lesions, and UVA and visible light can penetrate clouds and window glasses. The dermatologists say that pigmentation from visible light is darker than pigmentation from UV and will last longer. Iron oxide is a component of tinted sunscreens that help by absorbing visible light, and when iron oxide was added to a sun-screen that was designed to block UV, it blocked melasma.
  
• Heat: It is another well known environmental risk factor. Some individuals may be especially sensitive to prolonged or strong exposure to heat which can be linked with melasma. Exposing processes to heat may impact both the production of pigment and the worsening of melasma; heat effects are not yet understood and require more research. 

Skin Irritation and Inflammation

Melasma can look worse if skin irritation and inflammation worsens. They can also lead to post-inflammatory hyperpigmentation; dark marks that develop after the skin is irritated or injured. Irritation can be caused by:

• Rough scrubbing, over exfoliation or use of lemon juice on the face.
• Any skin lightening products that burn or sting on the skin especially when used without professional supervision.
• Skin damage (waxing, threading etc).
• Chemical peels, lasers or light therapy can be irritating and potentially trigger an increase in skin pigmentation, even when applied professionally (unless advised), avoid these treatments.

Pigmentation can also be accentuated by inflammation even in the absence of additional sun damage, but also by sunlight. 

Symptoms of Melasma

Melasma is a common skin condition that causes discolouration in the form of dark patches, primarily on sun-exposed areas. While not harmful or painful, it can significantly affect one’s confidence because of its visible appearance. Understanding its symptoms is crucial for early recognition and effective management.

• Brown or Gray-Brown Patches: The most distinctive feature of melasma is the presence of uneven, dark-colored patches. These patches may appear brown, gray-brown, or even bluish, depending on the individual’s skin tone and the severity of the condition.
• Facial Localization: Melasma commonly affects the face, particularly the cheeks, forehead, nose, chin, and upper lip. The symmetrical appearance across the face is a hallmark sign.
• Sun-Exposed Areas: In some cases, melasma can develop on other sun-exposed areas of the body, such as the neck or forearms. Prolonged exposure to sunlight often triggers or worsens the discolouration.
• Symmetry: The patches are usually symmetrical, appearing evenly on both sides of the face. This symmetry helps distinguish melasma from other skin conditions. 
• No Pain or Itching: Melasma does not cause physical discomfort such as pain or itching, but its visible appearance can lead to emotional distress or self-consciousness in individuals.
• Triggers: The condition may worsen due to hormonal changes, such as during pregnancy or while using birth control pills. Additionally, certain skincare products and UV exposure can aggravate melasma.

Recognizing these symptoms early can help individuals seek appropriate treatment and prevent the condition from worsening.

Other Factors That May Worsen Melasma

Heat Exposure and High Temperatures

In summer, your melasma may worsen and heat and sunlight could be a component. It can be due to hot kitchens, saunas and steam rooms, hot long vehicles or hot and humid weather. Apply shade, fans and cooling and sun protection in combination.

Hormonal Contraceptives

Commonly reported triggers are contraceptives containing estrogen or progesterone, such as birth control pills, IUDs, and implants. Tell your doctor if the melasma started after taking your contraceptive. The dermatology guidelines recommend discontinuing hormonal contraceptives as much as possible, but that is always up to your doctor.

Pregnancy-Related Hormonal Changes

The skin changes that occur during pregnancy, or “mask of pregnancy,” are known as melasma. Usually starts during pregnancy and may disappear after giving birth to a baby, but can return with subsequent pregnancies. Risk factors are family history, previous melasma in pregnancy, multiple pregnancies and sun exposure. When pregnant, consult your doctor about whether any skin treatments and products are safe before applying.

What Causes Melasma on the Face?

The face is the most common site because it receives the most daily light, and melasma tends to develop on sun-exposed skin. The same triggers described above, acting on the face, produce a recognisable pattern.

What melasma on the face looks like:

• Brown, grey-brown or sometimes bluish patches with irregular borders
• Usually symmetrical, mirroring each other on both sides
• No pain, itching or scaling 

Pattern	Where it appears	Notes
Centrofacial	Forehead, cheeks, nose, upper lip (sparing the area just under the nose)	The most common pattern, 50–80% of cases
Malar	Cheeks and nose	Common, especially in men
Mandibular	Jawline and chin	Less common
Extrafacial	Forearms, upper arms, shoulders	Sun-exposed distribution

Colour and edge sharpness depend on depth. Epidermal melasma is dark brown with well-defined borders. Dermal melasma is light brown to blue-grey with blurred edges. Mixed melasma combines both. A dermatologist uses a Wood’s lamp or dermoscope to tell them apart. See our guides to the types of melasma and dermal melasma.

Other conditions can look similar: post-inflammatory hyperpigmentation, sun spots (solar lentigines), freckles, drug-induced pigmentation, and the nevus of Ota and Hori. This is why an accurate diagnosis matters before you treat.

What Causes Melasma on the Upper Lip?

Melasma on the upper lip may develop when pigment-producing cells become overactive, resulting in a darker patch above the lip. Hormonal changes and the sun, as well as genetic predisposition, may be factors. Melasma often occurs on the upper lip, and the area can be fairly symmetrical. It can be termed a “melasma moustache.” 

But this darkness around the upper lip is not necessarily melasma. Other potential factors are: 

• Irritation following hair removal: Waxing, threading, tweezing or shaving can cause irritation and damage to the skin. During the healing process, a dark mark, called post-inflammatory hyperpigmentation (PIH) may be left behind in the skin.
• Acne or small skin injury: Any kind of skin irritation or pimple around the mouth will leave pigmentation on the skin once they heal.
• Contact reactions: Lip products or toothpaste may cause skin irritation around the lips or darkening of the lips.
• Other medical conditions/medications: Pigmentation around the mouth can also be triggered by other medical conditions or medications. 

Feature	Melasma	Post-inflammatory hyperpigmentation	Acanthosis nigricans
Typical appearance	Flat brown or grey-brown patches, often appearing on both sides	Dark marks in areas where the skin was irritated or injured	Dark, thickened skin with a velvety texture
Possible association	Sunlight, hormonal changes and genetic tendency	Hair-removal irritation, acne or injury	Often associated with insulin resistance
Location	May affect the skin above the upper lip	Can occur where irritation happened	Usually affects skin folds; the lips are a less common site

These are general clues for educational purposes, not a part of diagnosis. A dermatologist can examine persistent or changing pigmentation and determine its cause. If the patch is thick or velvety, or is changing quickly, have it checked by a dermatologist.

Melasma in Men and Women (লিঙ্গভেদে মেলাসমা)

Melasma is more common in women, but men are affected more than many people expect. In some series, men are about 10% of cases, and in two Indian studies they were 20–26%. I could not find Bangladesh-specific figures, so regional Indian data are the closest comparison.

	Women	Men
Typical onset	Usually 20–40 years	Often the 30s and 40s in a 72-man study
Leading triggers	Hormones (pregnancy, pills, hormone therapy) plus sun	Sun exposure was documented as the main cause in most studies
Sun exposure reported	23.9% in one Indian study	48.8% in the same study
Family history	20.1% in the same study	39% in the same study
Hormone tests	Hormonal triggers are central	Usually normal; a few men had low testosterone or high LH (2.8% in one study)
Common pattern	Centrofacial	Malar was most common (52–65%)]

What Causes Melasma on the Face in Women?

Hormonal triggers dominate: Pregnancy, Estrogen or Progressive Contraceptives, IUDs, implants, HRT, and the sun/heat. In addition, thyroid disease is associated. There are cosmetics, perfumes or any hair removal around the upper lip that contributes to the image. 

What Causes Melasma on the Face in Men?

In males, the primary documented cause is sun exposure and outdoor occupations are a significant risk factor. Family history also is common. Other signs suggest it, and although hormones are not responsible for the majority, a doctor may order tests for thyroid, liver or testosterone, if there is a small percentage of men who had test results for these areas. 

In one study of Indian men with melasma, 62% said they used mustard oil as a hair or skin treatment, and suggested that UV light and mustard oil are key factors responsible for the condition. This is not direct proof but association, but may be important to discuss with your dermatologist if you apply oils to your hair and/or skin on a daily basis. 

How To Stop Melasma from Worsen?

This article is about causes, but these steps address the triggers directly:

• Use a broad-spectrum sunscreen daily. Dermatology guidance for melasma suggests SPF 50+ containing iron oxides for visible light, plus a hat and shade.
• Avoid tanning beds and midday sun.
• Keep heat down while cooking, exercising and travelling. 
• Review medicines and hormonal contraception with your doctor before changing them. 
• Be gentle with your skin. Avoid harsh scrubs, DIY lightening remedies and aggressive hair removal on the face. 
• Get a dermatologist’s diagnosis before using strong lightening agents.

For treatment options, see our guides to the best melasma treatment for Bangladeshi skin and melasma laser treatment.

What Is The Fastest Way to Treat Melasma?

With honesty, there is no fastest way to treatment melasma but a combination of medical approach prescribed by clinical dermatologists will help you getting rid of it safely, without any harmful side effests. Although melasma is difficult to manage, but managable.

The right treatment options can help reduce dark patches and improve skin tone. The treatment options may include topical creams (hydroquinone creams, Alternatives like azelaic acid, kojic acid, and tranexamic acid are gaining popularity for their gentler yet effective results), Retinoids such as tretinoin help by promoting skin cell turnover, which gradually fades dark patches.  chemical peels, laser treatments and other dermatologist-recommended procedures including sun protection, depending on your skin condition and the severity of pigmentation.

With personalized care and advanced technology, SUO XI Hospital (Skin Care) helps you achieve a brighter, more even skin tone while minimizing melasma recurrence. Visit our skin care clinic in Dhaka and get the best melasma removal treatment at an affordable cost.

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