Chloasma · What Is It, Symptoms, Treatment, and More

Chloasma, more commonly known as melasma, is an acquired pigmentary disorder of the skin, characterized by areas of discoloration known as hyperpigmentation. Hyperpigmentation refers to the darkening of one’s natural skin color due to an increased deposition of melanin, which is the pigment that determines eye, skin, and hair color. Chloasma typically occurs symmetrically on both sides of the face and can sometimes occur in other sun-exposed areas.   

Chloasma can affect both individuals assigned male and female at birth, although it’s much more common among those assigned female. Darker-skinned individuals and those who tan easily are at a higher risk than fair-skinned individuals, since they naturally have more melanin in their skin.  

Chloasma presents with flat, irregularly-shaped skin patches that appear darker in color than the surrounding skin and have a net-like, or reticulate, appearance. Depending on the site of melanin deposition within the layers of the skin, the color of the lesions can vary from light to dark brown and, occasionally, ash-blue. The skin patches are often distributed symmetrically over sun-exposed areas, most notably on the cheeks, but can also occur on the nose, upper lip, chin, and forehead. The skin patches are typically well-circumscribed, ranging from less than 1 centimeter (cm), or about a third of an inch, to over 10 cm in size.  

Although chloasma does not typically cause symptoms, such as itching or pain, it can cause considerable cosmetic concerns and psychological distress, which may significantly impact the quality of life of the affected individual. 

There are several treatment options for chloasma, including skin-lightening agents, chemical peels,  laser or light-based therapies, and microdermabrasion. Skin-lightening agents are topical medications that aim to lighten hyperpigmented areas by decreasing melanin production. These medications include hydroquinone, retinoids, topical corticosteroids, azelaic acid, and tranexamic acid. All these medications can be used as single agents or, more often, in combination with each other.   

Individuals who do not respond well to these medications can be treated with chemical peels (e.g., glycolic acid), which aim to remove excess melanin from the skin’s surface, thereby decreasing hyperpigmentation. Chemical peels are often used in combination with skin-lightening agents to maximize effectiveness.  

If unresponsive to all other treatment options, individuals may receive laser therapy or light-based therapies to remove pigmented areas of skin. Finally, microdermabrasion, a non-invasive skin resurfacing procedure that exfoliates the outer layer of dead skin cells, can improve texture and tone, offering brightening and mild reduction of superficial pigmentation.  

Treatment of chloasma can sometimes be challenging, as it tends to be a long-lasting condition and may reoccur over time. As a result, maintenance therapies and strict sun protection are often necessary to control the condition. Regardless of the chosen treatment, certain measures can be taken to prevent further progression of chloasma, including avoiding or minimizing sun exposure, using broad spectrum sunscreens, and wearing wide-brimmed hats to protect the face from the sun.