What Is Causing My Patchy-Looking Skin?

Have you noticed uneven patches of darker skin on your face, arms, or neck? You might have melasma, a common (but often misunderstood) skin condition. 

Dr. Robert Topham at Holladay Dermatology & Aesthetics in Holladay, Utah, specializes in diagnosing and treating melasma, helping patients achieve more even, healthier-looking skin.

Melasma isn’t dangerous, but it can be frustrating. To manage this condition effectively, you must understand its causes, triggers, and treatment options. This quick guide gives you an overview.

Melasma 101

Melasma is a common, harmless skin condition that occurs when your skin produces too much melanin, the pigment responsible for your skin’s color. This leads to darker, patchy discoloration, typically on the face (especially the cheeks, forehead, upper lip, and chin) and sometimes on the arms, neck, or other areas exposed to the sun.

Melasma can range from tan to dark brown or grayish blue, depending on your skin tone. It’s most common in women, particularly during their reproductive years, but it can also occur in men, albeit less frequently.

Related terms to know: 

Chloasma (the “mask of pregnancy”) is melasma triggered by hormonal changes during pregnancy. 

Mixed melasma is a combination of epidermal (skin surface) and dermal (deeper layer) pigmentation, and it responds differently to treatment.

Why do I have melasma?

Understanding what causes and worsens melasma is the first step to managing it. Several factors contribute to this condition:

Sun exposure

The most common trigger is exposure to ultraviolet (UV) radiation. The sun activates melanocytes (pigment-producing cells), increasing melanin and darker patches. Even brief sun exposure without protection can worsen melasma.

Hormonal changes

Hormone fluctuations are another key contributor, which is why women often experience melasma during pregnancy or while taking birth control pills or hormone replacement therapy (HRT). Melanin-stimulating hormones play a significant role in these cases.

Genetics

If someone in your family has melasma, you may be more prone to developing it. Studies show a potential genetic component in melasma occurrence.

Other triggers

Some of the lesser-known culprits behind melasma are:

• Skincare products or cosmetics that irritate the skin 
• Heat exposure and infrared radiation from tanning beds, ovens, or electronic devices 
• Certain medications, like anti-seizure drugs and photosensitizing medications 
• LED light screens from TVs, computer monitors, and smartphones 

Although melasma is harmless, its appearance can wreck your self-esteem and confidence. 

What are my melasma treatment options?

Melasma can be stubborn, but there are various treatments and management strategies. Here’s what Dr. Topham might recommend:

1. Sun protection

This is non-negotiable. Consistent sun protection prevents melasma from worsening and helps maintain treatment results. Use a broad-spectrum sunscreen with SPF 30 or higher daily — even on cloudy days — and reapply every two hours if outdoors.

Other sun-protection tips include wearing a wide-brimmed hat and seeking shade during peak sunlight hours.

2. Topical treatments

Over-the-counter and prescription creams can help reduce pigmentation. Look for ingredients such as:

• Hydroquinone for skin lightening
• Retinoids (tretinoin) to encourage skin cell turnover 
• Azelaic acid to inhibit melanin production 
• Glycolic acid and kojic acid for gentle exfoliation and brightening 

Combination therapies that pair hydroquinone, retinoids, and steroids might be your best bet.

3. Chemical peels

We may recommend chemical peels containing alpha hydroxy acids (AHAs) to remove the top layer of pigmentation. These treatments work well for milder cases of epidermal melasma.

4. Laser therapy

Advanced laser technology, such as the PICO Genesis Laser, targets and breaks apart melanin deposits without damaging surrounding tissue. This is ideal for more stubborn dermal or mixed melasma but should be performed carefully by an experienced dermatologist like Dr. Topham to prevent side effects like hyperpigmentation.

5. Oral treatments

Oral medications such as tranexamic acid may improve cases resistant to topical treatments.

6. Maintenance and follow-up

Melasma isn’t a one-time fix. Regular follow-up appointments with Dr. Topham and the following preventive measures are crucial to managing the condition in the long term.

Practical tips for living with melasma

Here are a few tips for managing melasma:

• Limit screen time to reduce infrared exposure from LED devices
• Consider using blue light screen protectors
• Test new skincare products carefully
• Use non-comedogenic, fragrance-free products
• Eat foods rich in vitamin D and antioxidants for overall skin health

Melasma might not have a permanent cure, but you can manage it with the right care and expertise. 

Schedule an appointment with Dr. Topham at Holladay Dermatology & Aesthetics today for personalized evaluation and treatment.