Have you noticed the appearance of brownish spots on your face that are similar to freckles but tend to cluster together in patches? This common skin condition sometimes appears in perimenopause and menopause and is called melasma. What is it, is it dangerous, and what can you do about it?

What is melasma?

Melasma is a common and harmless skin condition characterized by tan, brown, or gray-brown flat spots that typically appear on the cheeks, forehead, chin, above the upper lip, and nose bridge, and occasionally also show up on the arms and neck. Melasma is about nine times more common among women than men. It is especially prevalent among pregnant women, with about 50 percent of them developing the condition, according to the British Association of Dermatologists. 

Causes of melasma include genetics (which is believed to be a major factor), exposure to ultraviolet radiation, pregnancy, hormonal therapy, use of cosmetics, and taking phytotoxic or anti seizure medications. 

Read about supplements to improve skin during menopause

Melasma is believed to develop when melanocytes (pigment-producing skin cells) make too much pigment, or melanin. A hormone called melanocyte stimulating hormone (MSH) triggers the activity of the melanocytes. People with darker skin are more likely to develop melasma because their melanocytes are more active than those in people with light skin.

According to consultant dermatologist Dr. Sajjad Rajpar, melasma is “a really complex, chronic, inflammatory, serious skin condition. It can seriously affect the quality of life of the people who develop the condition and it can impair social comfort because of the appearance of it.” 

How is melasma associated with menopause?

Melasma is associated with elevated levels of estrogen and progesterone. Women who use hormone replacement therapy may get melasma because the higher hormones stimulate the melanocytes. Another factor associated with menopause is cortisol levels. Stress causes the body to make increasing amounts of cortisol, which in turn creates an imbalance in estrogen levels and impacts MSH levels, resulting in more melanin production. 

How can melasma be managed naturally?

Melasma may go away on its own or it may respond to preventive and management efforts. The following tips may help. 

• Avoid sun exposure. This is the best way to prevent and manage melasma. Because sunlight causes the skin to produce more pigment, you need to protect your skin at all times. Wear sunglasses, a wide-brimmed hat whenever you are outdoors (even when it’s cloudy), and use a broad-spectrum sunscreen (SPF 30 or higher) when outdoors. Choose a mineral sunscreen product that contains titanium dioxide and/or zinc oxide. These ingredients protect against both ultraviolet A and B rays and also are less likely to cause skin irritation. 
• Beware of cosmetics use. Avoid routine use of cosmetics on sensitive skin, especially any creams that contain steroids. 
• Follow an anti-inflammatory diet. Focus on foods high in antioxidants and phytonutrients, including lots of fruits and vegetables, healthy fats, and cold water fatty fish, which are rich in omega-3 fatty acids. 
• Try supplements. Supplements that can support healthy skin include green tea extract, astaxanthin, omega-3 fatty acids (fish oils), niacinamide (vitamin B3), Polypodium leucotomos, and grape seed extract. Take according to package directions or your doctor’s recommendations.
• Use natural topicals. Several natural topical products may be helpful. Kojic acid, which is found naturally in mushrooms and soy, decreases the amount of pigment in melanocytes. This acid can cause skin irritation, however. L-ascorbic acid (vitamin C) can prevent absorption of ultraviolet radiation, which in turn stops melanin from forming. Glutathione, which is composed of three amino acids (cysteine, glutamic acid, glycine), is a potent antioxidant with anti-inflammatory properties. In a randomized controlled trial, oral glutathione use resulted in a decline in melanin when compared with placebo over four weeks.  

When to call your doctor

Melasma doesn’t cause any physical harm, but it can cause emotional distress. If melasma is disrupting your life, contact your healthcare provider who can discuss medical options with you if you so choose, including hydroquinone, a skin lightening agent.

Bottom line

Melasma is a dermatological condition that is common among women in perimenopause and menopause. Although not physically harmful, it can cause emotional distress for some women. Preventive and management steps can be taken to help reduce the impact of this skin issue.