What should you know about cortisol melasma?

Melasma produces flat brown or grey-brown patches, often on the cheeks, forehead, upper lip, or jaw. It can be influenced by hormones, heat, ultraviolet exposure, and visible light. Stress may affect sleep, inflammation, and routines, but a cortisol test does not by itself confirm that facial patches are melasma.

A clinician can distinguish melasma from post-inflammatory pigmentation, medication-related change, or a mole that needs separate attention. Patterns on both sides of the face often support melasma, while a single changing or bleeding spot needs direct examination.

Use broad-spectrum sun protection every day, add a hat or shade, and reapply as directed when outdoors. Tinted protection may help limit visible-light exposure. Choose gentle, fragrance-free products and avoid picking, harsh scrubs, or treatments that cause burning, because irritation can deepen discolouration.

A dermatologist may discuss prescription pigment treatments or procedures such as chemical peels, microneedling, skin brightening treatment, or laser toning. These options require careful selection because inflammation after a procedure can worsen pigmentation, particularly in deeper skin tones.

Book a review if patches appear suddenly, change quickly, itch persistently, bleed, form a sore, or differ from the usual pattern. Seek advice before starting pigment treatment during pregnancy, while breastfeeding, or when taking medicines that affect hormones or light sensitivity. Persistent or distressing pigmentation is also a reasonable reason to request a diagnosis.

Does this pattern fit melasma or another cause of dark patches? Could a medicine, hormone change, or skin irritation be contributing? Which sunscreen and pigment treatment suit my skin tone? How will we reduce the chance of darkening after a procedure?