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A new study addresses gaps in what novel pathogenic factors can be linked to melasma, specifically with diet, living environments, and other lifestyle factors.1 Interestingly, alcohol intake was found to be a potential trigger for melasma. These and other findings differ from pre-established causes like sun exposure, hormonal changes, and genetic history.2
The case-control study took place at Jiangsu Province Hospital of Chinese Medicine from April to October 2023. The mean age of the 150 patients was 39.98 with 96% of them being female. Nearly half of participants had a Fitzpatrick skin type of III with the rest of the patients being categorized as II or IV. About 30% had a family history of melasma, especially in first-degree relatives. After analyzing the facial lesions, the median melasma area severity index (MASI) was 7.5. Zygomatic and cheeks were the most commonly affected parts with a patchy, centrofacial topographical preference of 54.67%.
A control group of 142 healthy volunteers without melasma was also included in the study. This group had no statistically significant differences in gender, age, and body mass index compared to the case cohort. In both groups, investigators analyzed demographic and clinical characteristics as well as risk and protective factors.
The univariate and multivariate analyses further confirmed that previous sunburn or exposure to sun ≥ 2 h/day (OR: 19.43, 95% CI: 4.72–79.99), as well as an irregular menstrual cycle (OR: 4.32, 95% CI: 1.28–14.50), can be key risk factors for melasma. This has already been found in previous studies.
However, this research is the first to identify a strong positive relationship between alcohol intake and melasma (OR: 20.05, 95% CI: 1.17–343.17). This could potentially be due to the liver dysfunction associated with consuming alcoholic beverages, but more research is needed to confirm the underlying mechanisms.
The study found an additional new trigger in breast cystic hyperplasia, which is more common in women (OR: 15.98, 95% CI: 4.28–59.72). This condition is associated with stress, abnormal hormone levels, and genetic history, which are existing factors in melasma occurrence.3
Several other features were identified as potential reductions for the risk of melasma, which include change of residence (OR: 0.03, 95% CI: 0.00–0.30), house renovation (OR: 0.13, 95% CI: 0.03–0.58) and soft drink intake (OR: 0.04, 95% CI: 0.00–0.83). Relocation and renovation in cities with healthier, less polluted areas could be the reason for this. Additionally, soft drinks may contain vitamin C, which has been proven to manage pigmentary disorders like melasma.
Other interesting findings include the use of oral contraceptives (OR: 1.73, 95% CI: 1.00–2.98), a habit of rubbing the face (OR: 1.70, 95% CI: 1.00–2.90), and insomnia (OR: 1.88, 95% CI: 1.18–2.99), as other potential triggers for melasma.
The study does have several limitations including the lack of a diverse population and detailed analyses of subclass. The retrospective design may also create contradictory findings. Larger, multi-center studies with further analysis “would help determine whether our findings hold true across different demographic and geographic contexts,” according to the authors.
Prior to this, there have been very few previous epidemiological case-control studies that have explored how these factors may lead to the onset of melasma, especially in the underrepresented Chinese population.
“These findings collectively underscore the multifactorial nature of melasma and the importance of systemic, environmental, and lifestyle factors in its development,” the authors concluded. “Addressing these factors may lead to improved preventive and therapeutic strategies for this condition.”
References
1. Shi Y, Guo S, Tan C. Diet and Living Environment as Novel Etiological Factors for Melasma: The Results Form a Retrospective Case-Control Study of 150 Chinese Patients. J Cosmet Dermatol. 2025;24(2):e70038. doi:10.1111/jocd.70038
2. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-782. doi:10.1590/abd1806-4841.20143063
3. Espósito MCC, Espósito ACC, Jorge MFS, D’Elia MPB, Miot HA. Depression, anxiety, and self-esteem in women with facial melasma: an Internet-based survey in Brazil. Int J Dermatol. 2021;60(9):e346-e347. doi:10.1111/ijd.15490