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Where do these dark spots on my face come from?

This is a skin condition that causes darkening the skin, usually on the face.  There could be one little area of brown on the upper lip, or the entire forehead, cheeks, and chin are affected to varying degrees.  The color tends to be light to dark brown and usually worsens with excess sun exposure.  Although most patients with melasma are female; it is possible for a man to have it.  Sometimes these brown spots appear during pregnancy, after starting birth control pills, and even with certain medications.  The exact cause of melasma is not known.  Hormones may cause a role, but it is more complex than that.

Melasma tends to be chronic.  This means treatment is ongoing and I can’t offer a “cure” for it.

Treatment Options

Treatment for melasma usually starts with topical therapies.  Most patients start with over the counter bleaching or fade creams.  I typically have a treatment protocol that starts with prescription medications.  For some patients, I will work with a compounding pharmacy to create a specialized prescription that includes multiple medicines that can help treat it.

If topical therapy does not work then the next step tends to be laser therapy.  Laser can include either non-ablative treatments such as Broadband Light (BBL) or ablative treatments such a Fractional or Halo Laser.  Studies show that laser can be beneficial to melasma, neutral to melasma, and in some cases may make it worse.


All patients must adhere to a strict sun protection routine.  This includes sunscreen, hats, and finding shade.  Makeup that has sunscreen in it typically is not enough.  I have seen numerous times where a patient will have their melasma well controlled and then come back from a beach vacation and notice a few weeks later it is flaring up.

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