While melasma is most famous for appearing on the face (the "mask of pregnancy"), it can also appear on other sun-exposed areas like the back, neck, and forearms—a condition known as extra-facial melasma . Dealing with dark patches on your back can be frustrating, especially when you want to wear open-back styles or hit the beach. Here is a guide to understanding and managing melasma on the back. What is Melasma on the Back? Extra-facial melasma presents as flat, dark, or blue-gray patches of hyperpigmentation. It occurs when melanocytes (pigment-producing cells) overreact to triggers, creating uneven patches instead of a uniform tan. Common Triggers: Sun Exposure: The primary culprit. UV radiation stimulates pigment production. Hormonal Changes: Pregnancy, oral contraceptives, or hormone replacement therapy often trigger these spots. Heat: Not just UV light, but even intense heat (like from saunas or hot environments) can worsen melasma. Post-Inflammatory Hyperpigmentation (PIH): Sometimes what looks like melasma on the back is actually PIH from old acne or irritation. How to Treat Melasma on the Back Because the skin on the back is thicker than facial skin, it can sometimes handle stronger treatments, but it is also harder to reach. 15 sites Melasma Causes & Treatments | Santé Clinics Barcelona. Jan 25, 2026 —