Aesthetic Medicine: March 2021

What Causes a Melasma Mustache and How to Treat It

Corey Whelan

March 1, 2021 ( — Melasma is a skin condition that causes brown or grayish-brown patches to occur, mostly on the face. When it appears on the upper lip, this condition is referred to as a melasma mustache.

Melasma is more likely to occur in reproductive-aged women than it is in men. It’s also common during pregnancy, affecting 15 to 50 percent of pregnant women. During pregnancy, melasma is referred to as chloasma. It’s also sometimes called the mask of pregnancy.

A melasma mustache isn’t painful, but can make you self-conscious, and in some cases, can be emotionally upsetting to deal with.

In this article, we’ll explain the possible causes and treatments for a melasma mustache.

What causes a melasma mustache?

The exact cause of a melasma mustache is unknown, although specific factors play a role. Primary risk factors include:

  • sun exposure
  • hormones
  • genetics/family history

Other risk factors for melasma mustache include:

  • frequent exposure to the sun’s ultraviolet rays
  • living in high altitudes
  • thyroid disease
  • taking anticonvulsant medication

Having more than one of these factors increases your odds of getting a melasma mustache

A combination of the above risk factors may increase your chances of getting a melasma mustache. Around half of all people with this condition have a family history of melasma. Identical twins have also been found to both have melasma.

An increase or fluctuation of estrogen and progesterone may trigger pigment-producing skin cells to boost melanin in sun-exposed areas of skin. This, in turn, causes the formation of melasma patches.

What do they look like?

Melasma patches are brown or grayish-brown. They may form on your upper lip, or on other parts of your face or neck. They’re often symmetrical. They may appear under each nostril, or on your entire upper lip, giving it a darkened, mustache-like appearance.

Melasma mustaches are more likely to occur in women

Because estrogen and progesterone play a role, melasma is more likely to occur in women than in men, although men can also get melasma mustaches.

Hormonal fluctuations or surges during pregnancy also increase the risk of melasma. Using hormonal contraceptives, or hormone replacement therapy, may also increase risk.

Skin color may also be a factor

Skin color is also a factor. Darker skin types have more active pigment-producing cells than light-colored skin. You’re more likely to get a melasma mustache if your skin is light- to medium- brown. Very light and very dark skin types are not usually affected.

Are there other symptoms that accompany a melasma mustache?

A melasma mustache has no additional symptoms. It doesn’t itch, and it doesn’t cause pain or swelling. If you have a melasma mustache, you may, however, notice other discolored patches on your face.

Melasma only happens to sun-exposed areas of skin. Common sites for melasma include:

  • cheeks
  • forehead
  • bridge of the nose
  • chin
  • neck
  • forearms

What’s the best way to treat a melasma mustache?

If you develop a melasma mustache during pregnancy, it may disappear on its own once you’re no longer pregnant.

A melasma mustache caused by taking hormonal contraceptives or hormone replacement therapy may also disappear once you stop taking the medication.

In other instances, a melasma mustache may last for decades unless treated. Even with treatment, melasma can take many months to resolve completely. Treating a melasma mustache requires patience and a commitment to removing possible triggers.

Eliminate triggers

Once your doctor confirms you have a melasma mustache and not another condition, they’ll first recommend lifestyle changes to eliminate any triggers that may be causing the melasma patches.

This includes year-round, lifetime use of a sun blocker that stops exposure to UVA and UVB light. Mineral sunscreens containing iron oxide are preferred, as they block visible light which can exacerbate melasma.

Heat — such as cooking over a hot stove — is also a melasma trigger and should be avoided if possible.

Wearing sun-protective hats with wide brims can also help keep the sun off your face.

You may also consider changing your birth control method to a non-hormonal type, such as a copper IUD.

For some people, certain perfumes, cosmetics, and creams may become activated by exposure to sunlight. This is known as a phototoxic reaction. In some instances, a phototoxic reaction can trigger melasma. Identifying and eliminating products that react to sunlight may help.

Topical treatments

Hydroquinone, a topical skin lightening cream, is often recommended as a first-line treatment. Low-dose, two percent hydroquinone can be purchased online or over the counter.

Dermatologist may also prescribe medications that combine hydroquinone with other ingredients, such as:

  • tretinoin
  • mild steroids
  • vitamin C
  • kojic acid
  • azelaic acid
  • tranexamic acid

Topical treatments containing hydroquinone may start to lighten melasma mustache patches after about one month’s use.


Prolonged use of hydroquinone can result in ochronosis, a condition earmarked by blue-black patches of skin. In some instances, hydroquinone may also cause white spots to appear on skin.

You should not use hydroquinone or other topical treatments for a melasma mustache on skin that does not have melasma.

Skin peels and other facial treatments

If topical treatments don’t work after several months, your doctor may recommend trying a skin peel comprised of glycolic or salicylic acid-based compounds. Most peels for melasma contain a blend of acids including low concentration trichloroacetic acid (TCA).

These peels work for some people, but may worsen melasma in others. You and your doctor can decide if peels make sense for your skin type.

A superficial, low-concentration peel may be done monthly, to start. In some instances, your doctor may recommend increasing the frequency and concentration of the peels. You may also be told to combine topical use of a lightening agent, such as hydroquinone, with the skin peels.

Other treatments such as lasersmicrodermablasion, and microneedling have had mixed results for melasma mustache. Like laser treatments, they should only be done by a trained medical professional, such as a dermatologist.

Warning about scam treatments for melasma mustaches

A melasma mustache is front and center on your face. This may make you self-conscious, and anxious to try anything that promises to work quickly. These may include online or over-the-counter “scam” treatments, such as skin lighteners and skin whiteners which come from disreputable sources.

Some of these scam treatments are topical. Others are oral or injectable “medications.”

Using treatments that have not been recommended by a doctor can be dangerous and may permanently damage your skin. For example, some topical skin whitening products may contain mercury or high potency steroids. Injected glutathione products sold for the treatment of melasma may cause thyroid or kidney damage.

Always check with a doctor before trying any over-the-counter or internet treatment for a melasma mustache.

What’s the difference between a melasma mustache and an age spot?

Age spots are another condition caused by excessive melanin production and overexposure to the sun.

Unlike melasma mustache, age spots are more likely to occur in people with fair skin. Age spots are also more common in older people, as opposed to melasma mustaches, which are most common in women ages 20 to 40.

As their name implies, age spots usually look like spots. They may appear as a cluster, or alone. A melasma mustache looks more like patches than spots. Age spots are also unlikely to be symmetrical, another common feature of melasma.

A doctor, such as a dermatologist, has tools for diagnosing both conditions, and can tell the difference between the two.


A melasma mustache is a skin condition most likely to occur in women with specific risk factors. These include extensive sun exposure, having light brown skin, and fluctuating hormones, such as those caused by pregnancy.

Genetics and family history of this condition also play a role.

Melasma is not completely understood, and can be challenging to treat. Seeing a doctor such as a dermatologist can help. Often, prescription topical treatments will be enough to diminish a melasma mustache.

Treating this condition usually takes time. Having patience during treatment, and seeking support from others, may help.

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