Hyperpigmentation and melasma in midlife

Melasma shows up as symmetric patches of darker skin, most often across the cheeks, forehead, upper lip, and jawline. It is strongly associated with sun exposure, heat, and hormonal shifts, which is part of why it can appear or change during pregnancy, with hormonal contraception, and across the menopause transition.

What is understood

• Ultraviolet light and visible light both contribute, and visible light matters more for deeper skin tones
• Heat alone, including from cooking, saunas, and hot flashes, can worsen patches
• Melasma often recurs, and treating it is usually about long-term management rather than a single fix
• Friction and irritation can deepen a patch, so aggressive scrubbing tends to backfire

Why it is not a cosmetic footnote

Surveys of people living with melasma consistently report meaningful effects on confidence, social comfort, and mood. For women of color who are also navigating dismissal elsewhere in the health system, being told a visible change is "just cosmetic" can end a conversation that should have continued.