Melasma
Overview
Melasma is a common acquired pigmentation disorder showing symmetric light- to dark-brown patches, mainly on the cheeks, forehead, upper lip, and nose; it is strongly associated with sun exposure, genetic predisposition, pregnancy, oral contraceptives or hormone therapy, and darker skin types, and often worsens in summer. Chinese medicine names it 'li hei ban', attributing it mainly to liver qi stagnation with blood stasis or to liver-kidney yin deficiency with poor facial nourishment. Strict photoprotection is central; lightening is gradual and recurrence is common.
TCM disease & pathogenesis
TCM names this li hei ban ('dark black patch'), liver spot, or facial dust; when occurring in pregnancy it is the pregnancy mask. The site is the face, related to liver, spleen, kidney, qi, and blood. The face is the gathering of all yang; when qi and blood cannot rise to nourish it, brown patches form. Common causes are emotional constraint with liver qi stagnation and blood stasis clouding the face; overstrain injuring the spleen so it fails to produce sufficient qi and blood to nourish the face; or sexual/exertional overtaxation and chronic illness causing kidney yin deficiency with deficient fire flaming upward. The most common patterns are liver qi-blood stasis and liver-kidney yin deficiency. Treatment soothes liver and moves qi, quickens blood, nourishes blood and softens the liver, or enriches liver-kidney yin to downbear fire, while strict sun protection removes the external trigger.
Pattern differentiation (clinical patterns)
Liver Stagnation, Qi Stasis and Blood Stasis
Symmetric diffuse dark-brown patches that deepen with low mood or before menstruation, hypochondriac fullness, irregular periods, pale-red tongue or stasis spots, wiry pulse.
Soothe the liver and regulate qi; quicken blood and fade the patches.
Liver-Kidney Yin Deficiency
Dark-brown fairly well-defined patches with sore weak lower back and knees, dizziness and tinnitus, heat in the five centers, red tongue with scant coating, fine rapid pulse.
Nourish liver-kidney yin; nourish yin and fade the patches.
Connections
Daily care & prevention
Apply broad-spectrum high-SPF sunscreen daily and reapply, wear a hat and seek shade, and avoid irritating skin products and unnecessary hormone exposure; ensure adequate sleep and manage stress; be patient, as fading takes months. Press Xuehai (SP10), Sanyinjiao (SP6), Zusanli (ST36), Taichong (LR3), Pishu (BL20), and Ganshu (BL18). A single, rapidly changing or irregular dark lesion should be examined.
When to seek medical care
Have a dermatologist examine any one-sided, rapidly darkening or enlarging, irregularly bordered, non-symmetric pigmented lesion (to exclude melanoma or other disease), a mole following the ABCDE warning signs, or pigmentation accompanied by systemic symptoms.