Melasma appears as flat patches of light brown, dark brown, or blue-gray discoloration, most often on the face. The patches are symmetrical, meaning they typically show up in matching positions on both sides. Unlike a freckle or a single sun spot, melasma tends to form larger, map-like areas of uneven color that can spread across the cheeks, forehead, nose, or upper lip.
Color and Border Differences
The exact shade of a melasma patch depends on how deep the excess pigment sits in your skin. When pigment is concentrated in the upper layers of skin (epidermal melasma), patches look dark brown and have relatively sharp, well-defined edges. When pigment has settled deeper (dermal melasma), the color shifts to a lighter brown or blue-gray, and the borders look blurry or smudged, almost like a watercolor stain. Many people have a mix of both, which means patches can vary in color and clarity even on the same face.
The patches are always flat. They don’t raise above the skin surface, and they don’t itch, flake, or feel rough. If a dark patch is bumpy, scaly, or painful, it’s something else.
Where Melasma Typically Appears
Melasma follows recognizable patterns on the face, and dermatologists group them into three main types:
- Centrofacial: The most common pattern, accounting for 50 to 80 percent of cases. Patches spread across the forehead, cheeks, nose, and upper lip, but tend to spare the small groove between the nose and upper lip (the philtrum).
- Malar: Patches are limited to the cheeks and nose, giving the appearance of a “butterfly” pattern across the mid-face.
- Mandibular: Patches develop along the jawline and chin. This is the least common pattern.
In all three patterns, the discoloration is nearly always symmetrical. A patch on your left cheek will usually have a matching patch on your right cheek. This bilateral symmetry is one of melasma’s most distinctive visual features.
Though the face is the primary site, melasma can occasionally appear on the forearms, neck, or chest, particularly in areas that get regular sun exposure.
How It Changes With Sun, Heat, and Hormones
One of the most frustrating things about melasma is how much it fluctuates. Patches often darken noticeably after time in the sun, even on overcast days. Ultraviolet rays are a well-known trigger, but visible light and heat also intensify the discoloration. That means a hot yoga class, time near a stove, or sitting by a sunny window can all make melasma more prominent, even if you’re wearing UV sunscreen.
Hormonal shifts are the other major driver. Melasma is sometimes called “the mask of pregnancy” because it frequently appears or worsens during pregnancy, when estrogen and progesterone levels rise sharply. Hormonal contraceptives and hormone replacement therapy can have the same effect. In many cases, patches lighten on their own after delivery or after stopping hormonal medications, though this isn’t guaranteed and the timeline varies widely.
In winter or during periods of minimal sun exposure, melasma patches often fade somewhat, then return in warmer, brighter months. This seasonal waxing and waning is a hallmark of the condition.
How Melasma Differs From Other Dark Spots
Several skin conditions cause dark patches on the face, and they can look similar at first glance. Knowing the differences helps you identify what you’re actually seeing.
Sun spots (solar lentigines) are small, well-defined spots, usually 1 to 3 centimeters across, that range from light yellow to dark brown. They show up on the face, hands, forearms, chest, back, and shins. The key visual difference is size and shape: sun spots are discrete, coin-like dots, while melasma forms larger, irregular patches. Sun spots also don’t fluctuate with hormones or seasons the way melasma does.
Post-inflammatory hyperpigmentation (PIH) leaves dark marks after skin injuries like acne, burns, or cuts. These marks are typically much darker than melasma and correspond to the exact location of the original injury or breakout. If you can trace a dark spot back to a pimple or scratch that was there weeks ago, that’s PIH, not melasma. PIH also doesn’t follow a symmetrical pattern across both sides of the face.
Melasma’s combination of symmetry, larger patch size, blurry or map-like borders, and hormonal or seasonal fluctuation is what sets it apart visually from these other forms of hyperpigmentation.
What Skin Tones Are Affected
Melasma occurs across all skin tones, but it’s far more common in people with medium to darker complexions. On lighter skin, patches tend to look tan or light brown. On deeper skin tones, they may appear dark brown, grayish-brown, or ashy. The contrast between the melasma and surrounding skin can be subtle or dramatic depending on your natural skin tone and how recently the patches have been triggered by sun or heat.
Regardless of skin color, the patches share the same flat texture, symmetrical placement, and sensitivity to light and hormonal changes. The condition is overwhelmingly more common in women, though men can develop it too, typically showing the same facial patterns.