Melasma on Black skin, often called the "mask of pregnancy," is one of the most frustrating kinds of hyperpigmentation, because it settles on your face and tends to come back. Brown patches show up on your cheeks, forehead or upper lip, and they get darker as soon as the sunny days return. As a nurse for more than 10 years, I often meet women who have tried everything, sometimes harsh products, and end up with irritated skin and even darker patches. Melasma calls for patience, gentleness and medical advice. Here's what you need to know to recognize it, care for your skin without making it worse, and know when to see a dermatologist.

What is melasma?

Melasma is a chronic form of hyperpigmentation: pigment cells in the skin, called melanocytes, produce too much melanin in specific areas of the face. It isn't contagious and it isn't dangerous to your health, but it can take a real toll on your confidence.

It mostly affects women between 20 and 50, and it's much more common in skin types III to VI, meaning brown, mixed-race and Black skin. Men can get it too, although less often.

When it appears during pregnancy, it's called chloasma or the mask of pregnancy. It often fades in the months after giving birth, but not always completely, and it can come back with a later pregnancy.

What causes melasma on Black skin

There's no single cause: several factors work together.

Sun and light: UV rays, and also visible light, stimulate melanocytes. This is the main trigger and the main thing that makes melasma worse, even on very dark skin.
Hormones: pregnancy, birth control pills or hormone therapy can make it more likely to appear.
Genetics: melasma is more common when other women in your family have it.
Heat: cooking over a hot stove, saunas, intense workouts in the sun… heat seems to keep the patches going for some people.
Irritation: harsh products, aggressive scrubbing or fragrance applied to sun-exposed skin can leave dark marks on top of melasma.

How to recognize melasma

On Black and mixed-race skin, melasma usually looks like:

brown, gray-brown or bluish patches, darker than the rest of your face, with rather blurry edges;
a symmetrical pattern: both cheeks, the forehead, the bridge of the nose, the chin or the upper lip;
flat patches that don't itch or hurt;
an intensity that changes with the seasons: darker in summer, a little lighter in winter.

It can sometimes show up on the neck or forearms. Melasma is easy to confuse with other dark spots, especially post-inflammatory hyperpigmentation left by a pimple or irritation. To tell the different types of dark spots apart on darker skin, read my guide to dark spots on Black skin. Only a doctor or dermatologist can confirm the diagnosis.

My gentle daily routine, step by step

Treating melasma is a job for your doctor. But your daily routine matters a lot, both to avoid making it worse and to give that treatment the best chance to work.

Cleanse your face gently, morning and night, with a mild cleanser that doesn't strip your skin. No very hot water, no rubbing.
Moisturize with a simple product suited to your face. Comfortable skin tolerates prescription treatments better and gets irritated less.
Use sunscreen every single day, even in winter and on cloudy days: a broad-spectrum facial sunscreen, ideally tinted (the pigments in tinted formulas also filter part of visible light). Reapply if you're outdoors. I explain why Black skin needs it too in sunscreen and Black skin.
Add physical protection: a wide-brimmed hat, sunglasses, and shade during the hottest hours.
Apply fragrance to your clothes or covered areas rather than on your exposed face or neck. Some fragrance ingredients can cause dark marks in the sun. My tips are in how to use a scented body oil.
Be patient: the first changes usually take several weeks to a few months, and keeping melasma under control is a long-term commitment.

If melasma also shows up on your forearms or neck, follow the same logic: regular moisturizing, no friction and sun protection. For your body, a simple lotion applied to damp skin is enough; our body lotions contain glycerin, lactic acid and grape seed oil. You'll find every step in my body care routine for Black and mixed-race skin, and the basics of hydration in dry Black skin: my moisturizing routine.

What about treatments?

A dermatologist can recommend suitable treatments for hyperpigmentation, some of which are prescription-only, followed by a maintenance plan. Procedures such as chemical peels or certain lasers exist, but on darker skin they should only be done by an experienced professional, because irritation can make the patches darker. During pregnancy and breastfeeding, many treatments aren't recommended: always ask your doctor before starting anything.

Mistakes to avoid

Using skin-lightening creams sold outside regulated channels: some contain steroids, hydroquinone or mercury. They can damage your skin for the long term and, ironically, leave darker patches.
Rubbing or scrubbing your face to "remove" the patch: melasma doesn't come off the surface, and irritation adds post-inflammatory marks.
Applying lemon juice, baking soda or irritating DIY recipes: they weaken your skin barrier and can cause burns in the sun.
Skipping sunscreen in winter or once things look better: a few sun exposures are often enough to bring the patches back.
Stopping hormonal birth control on your own: if you think your pill plays a role, talk to your doctor.

When to see a doctor

Make an appointment with a doctor or dermatologist, ideally one experienced with darker skin:

to confirm the diagnosis before starting any treatment for dark spots;
if a spot is isolated, irregular, or changes color, size or texture, bleeds or looks different from the others: it should be checked without delay;
if the patches come with redness, itching or other symptoms;
if you're pregnant or breastfeeding and want advice on what's safe to use;
if your skin has reacted to a product (burning, grayish patches, thinning skin).

You can also book a skin care consultation to review your routine, alongside your medical follow-up.

FAQ

How do I get rid of the mask of pregnancy on Black skin?

The mask of pregnancy often fades in the months after giving birth, especially if you protect your skin from the sun every day. If it lingers, a dermatologist can suggest a suitable treatment, taking breastfeeding into account.

Can melasma go away permanently?

It can fade a lot, but it's a chronic condition: it tends to come back with sun, heat or hormonal changes. The goal is to keep it under control over time.

What's the difference between melasma and post-inflammatory hyperpigmentation?

Melasma forms symmetrical patches on the face with no visible cause. Post-inflammatory hyperpigmentation appears exactly where a pimple, bug bite or irritation was. You can have both at the same time.

Do I need sunscreen on Black skin if I have melasma?

Yes. Daily sun protection is the foundation of managing melasma, whatever your skin tone. A tinted formula is often recommended.

Can birth control cause melasma?

It's one of the possible triggers. Don't stop your birth control without talking to your doctor: they can suggest an alternative if needed.

In short

Melasma is a chronic hyperpigmentation of the face, more common on Black and mixed-race skin, and linked to sun, hormones and genetics. It shows up as symmetrical brown patches. The foundation is daily sun protection, a gentle routine with no friction, and follow-up with a dermatologist. Stay away from unregulated skin-lightening creams, and get any spot that changes checked.

Written by Aissatou, a nurse for more than 10 years and founder of WITH CARE.