Melasma: What Causes Brown Spots on the Face?

Woman Putting Cream on her Arm
Woman Putting Cream on her Arm. Jutta Klee / Getty Images

I received an email from a friend recently who developed melasma, or brown spots, on her face during her last pregnancy. Although they are fading, she was hoping I could recommend a product that would move the fading along a bit faster.

These are the causes of melasma on the face and how to treat it.

Causes and Symptoms of Melasma

Melasma shows up in the form of brown spots or patches on the cheeks, forehead, upper lip and nose.

It is most common in women during their productive years and it tends to with olive skin that tans easily. My friend fits this risk factor because she always looks tan, even in winter. She also lives in Texas, where the sun shines strong, and too much sun exposure exacerbates and likely contributes to melasma.

Melasma is more a cosmetic concern than a health concern. These brown spots tend to develop in women who undergo a surge in hormone levels due to pregnancy, oral contraceptive use or hormone replacement therapy (HRT) during menopause. So it makes sense that my friend, who just had a baby, developed brown spots, which in pregnant women are also called chloasma, or "the mask of pregnancy."

If you're not sure if your brown spots are melasma, you can consult a dermatologist. Doctors can use a black light or Wood's light (340-400 nm) to properly diagnose melasma.

The Difference Between Liver Spots and Melasma

Those annoying brown spots that show up on your face, hands and chest in your 30s and older are known as liver spots or sunspots and are largely caused by sun damage.

This is different from melasma. In this article, How Can I Erase the Liver Spots on My Face, Hands & Chest? I share four proven ways to get rid of them forever.

Treatment of Melasma

So what to do if you have these brown spots? The good news is the brown spots will fade a few months after birth, or once you go off oral contraceptives or HRT.

But if you are like my friend, and you want a bit of help along the way, there are treatment options available. Keep in mind it is best not to use these creams when pregnant or breastfeeding. You can try to conceal the spots with concealer in the meantime, but do wait until the baby is weaned to start treatment.

A great option for melasma are skin lightening creams. The key ingredient in these creams is hydroquinone. You can try prescription strength creams including Obagi Clear, Glyquin, Tri-Luma, and Solaquin, but they can be irritating to skin and require a doctor's script. I recommend over-the-counter creams which contain 2 percent Hydroquinone and work just as well.

Apply to brown spots once in the morning and once at night. Great options include:

Your doctor may also prescribe Tretinoin, which is a form of Vitamin A, and comes in the brand forms Aberela, Airol, Renova, Atralin, Retin-A, Avita, Retacnyl, Refissa, or Stieva-A. There are generic versions available, which are likely less expensive. Many women stock up on Retin-A when traveling abroad to Mexico or across the border to Canada because you can buy Tretinoin over the counter for about $20 in other countries.

If you do choose to self-medicate, do not use Tretinoin if you are pregnant.

Other treatment methods include Tazorac cream, Azelex, Differin gel, NeoStrata (glycolic acid in 10 percent form) and glycolic acid peels. Lasers have also proven effective in diminishing brown spots, but this is the priciest option.

The Importance of Sun Protection

Aside from topical treatments, the best cure for melasma is to stay out of the sun. Wear at least 30 SPF sunscreen on your face and make sure the sunscreen contains actual blockers such as zinc oxide and titanium dioxide. Stay under an umbrella when poolside or by the beach and at the very least, wear a wide-brimmed hat.