Doctor’s Note: Your Easy + Essential Guide to Melasma

As dermatologists, we know that dealing with melasma can be frustrating. Dark spots can make people feel self-conscious and impact their confidence. Finding the right treatment isn’t always easy, but we’re here to help. Watch the video on the right, or scroll down if you want to jump straight to our recommendations!

What is Melasma?

Melasma is a skin condition that causes brown or gray-brown patches on the skin, primarily on areas like the cheeks, forehead, upper lip, and chin. Sometimes, it’s also called “the mask of pregnancy” because it’s common among pregnant women. While it can appear on anyone, melasma is more frequent in women and those with darker skin tones.

Melasma Pictures

Melasma is easy to recognize by its distinct look. The most common signs are:

Patchy Brown or Gray-Brown Spots: Melasma appears as patches of dark skin that are often symmetrical, meaning they appear on both sides of the face.

Common Locations: These patches typically appear on the cheeks, nose, forehead, upper lip, and chin.

Melasma Borders: Look at the clear edges of the dark patches on the skin. This is common in melasma and is often caused by sun exposure and hormones.

Melasma Mustache: Dark patches above the lip, often caused by sun exposure and hormones.

Causes of Melasma

Melasma is triggered by an overproduction of melanin, the pigment that gives skin its color. Here are some common reasons why melasma occurs:

Hormonal Changes: Hormones are a major cause of melasma, which is why it often affects pregnant women or people taking hormonal birth control or hormone therapy.
Sun Exposure: UV light stimulates melanocytes (cells that produce melanin) and can worsen melasma, making sun exposure one of the biggest triggers.
Skin Irritation: Certain skincare products or treatments that irritate the skin can make melasma worse. This is because irritation can increase melanin production.
Genetics: Some people are more likely to develop melasma due to their genetic background.

Melasma vs Sun Spots

Melasma and sun spots may look similar, but there are a few key differences:

Melasma usually appears as larger, dark patches with a smooth edge and often shows up symmetrically on both sides of the face, like the cheeks or forehead. It’s often triggered by both hormones and sun exposure, so it’s common during pregnancy or with certain birth control.

Sun Spots are smaller, isolated dark spots caused mainly by sun exposure. They tend to appear more randomly on areas like the face, hands, or shoulders. Knowing these differences can help you understand what you’re dealing with and choose the right treatment.

How To Get Rid of Melasma

Managing melasma requires a mix of good skincare habits and lifestyle adjustments to prevent it from worsening. Here are some essential tips:

Skincare Tips:

Gentle Cleansing: Use a mild cleanser to avoid irritating your skin, which can make melasma worse.
Avoid Irritating Ingredients: Skip strong exfoliants or harsh products that can trigger melasma. Look for items labeled as gentle or suitable for sensitive skin.
Daily Moisturizing: Keep skin hydrated with a quality moisturizer to strengthen your skin barrier, which helps your skin tolerate other treatments better.
Nightly Treatment Routine: Apply prescribed creams, like hydroquinone or tretinoin, at night, as these can increase sun sensitivity.

Lifestyle Tips:

Wear Hats and Sunglasses: Protect your face from UV rays with a wide-brimmed hat and sunglasses whenever you’re outside.
Consider Birth Control Alternatives: If you’re on hormonal birth control and experiencing melasma, ask your doctor about non-hormonal options, as they may reduce melasma flare-ups.
Avoid Excess Heat: Heat from saunas, hot showers, or intense exercise can sometimes make melasma worse. Try to avoid overly hot environments if possible.

Together, these habits can make a big difference in managing melasma and preventing it from getting darker.

Melasma Before and After

When treating melasma, patience is key. Since melasma can be stubborn and often returns with sun exposure or hormonal changes, results may take time. Many people are curious about what melasma looks like before and after treatment. With the right combination of treatments, melasma can fade significantly, and dark patches can become lighter and less visible over time.

There are many treatments available for melasma, and each works differently. Common options include topical creams with ingredients like hydroquinone, azelaic acid, and tretinoin, which help lighten the dark patches. Chemical peels, which gently exfoliate the top layer of skin, can also improve melasma for some people. Other options like microneedling and laser treatments target deeper pigmentation but are usually done under a dermatologist’s guidance.

Bronzina E, Clement A, Marie B, Fook Chong KT, Faure P, Passeron T. Efficacy and tolerability on melasma of a topical cosmetic product acting on melanocytes, fibroblasts and endothelial cells: a randomized comparative trial against 4% hydroquinone. J Eur Acad Dermatol Venereol. 2020 Apr;34(4):897-903. doi: 10.1111/jdv.16150. Epub 2020 Jan 12. PMID: 31858658; PMCID: PMC7154540.

Melasma Treatment Overview

Managing melasma can be tough, but knowing the right treatment can really help. This graphic shows the best ingredients and strategies to manage and reduce melasma.

Unlike some other conditions, there isn’t a single step-by-step treatment plan that works for everyone with melasma. Each case is different, so what works for one person might not work for another. That makes melasma a frustrating condition to treat!

Treating melasma often requires a mix of treatments. Topical products like hydroquinone, tretinoin, and newer options like tranexamic acid can be helpful in reducing dark patches. Adding these to your skincare routine can make a difference.

If topicals aren’t enough, chemical peels and lasers may be options. However, these are usually not our first choice. We prefer to focus on strong sun protection and a good topical routine to help manage melasma.

Best Products for Melasma

Sun protection is *very* important for patients with melasma. Sun exposure exacerbates dark patches, and prolonged exposure can worsen dark patches to the point where medications/procedures do not work. Thus, consistent use of broad-spectrum sunscreens with SPF 50 or higher, coupled with protective clothing and sun avoidance strategies, is crucial to manage melasma. Look for tinted sunscreens with iron oxide (the ingredient often used to impart color to tinted sunscreens) to protect against blue light (ie from computer monitor). Apply three finger-lengths of sunscreen to face. Reapply every two to three hours.

Sunscreen for Melasma

For melasma, choose tinted sunscreens, as they provide added protection by blocking both UV rays and visible light that can worsen dark spots.

EltaMD UV Clear Tinted Face Sunscreen SPF

WEIGHTLESS LIQUID MINERAL SUNSCREEN WITH ZINC OXIDE SPF 30

EltaMD UV Physical Tinted Face Sunscreen

La Roche-Posay Anthelios Tinted Sunscreen SPF 50

Best Products for Melasma

For managing melasma, look for products with brightening ingredients like azelaic acid, tranexamic acid, niacinamide, and vitamin C to help reduce dark spots and even skin tone.

SkinMedica 2.0 Lytera Pigment Correcting Serum

Good Molecules Discoloration Correcting Serum

Topicals Faded Brightening and Clearing Serum

Do NOT wear metal-frame aviators when you have melasma. The metal can heat up, worsening your dark spots! 😎

Best Treatment for Melasma

When it comes to treating melasma, there are several prescription options that can help lighten dark spots and even out skin tone. These include hydroquinone, Tri-Luma, tranexamic acid, and azelaic acid. Each of these treatments works in a unique way to target melasma, and they’re often used together for the best results. A dermatologist can help you decide which treatment, or combination of treatments, may work best for your skin.

Hydroquinone

"Gold Standard" dark spot lightener
In the US, hydroquinone used to be over-the-counter. It is now prescription only.
Don't overuse due to hydroquinone risk

Tri-Luma

Tri-Luma combines 3 ingredients to fight melasma:

Fluocinolone (decreases inflammation)
Hydroquinone (reduces dark spots)
Tretinoin (reduces dark spots)

Tranexamic Acid

Pill version (650mg daily) is prescription only.
Can also buy in topical form over-the-counter.
Not suitable for everyone, especially those with a history of blood clots

Azelaic Acid

Reduces dark spots and inflammation
Azelaic Acid <10% is over-the-counter.
15-20% is prescription only.

Some countries have banned or restricted the use of hydroquinone because of concerns about its safety. Because people often misuse hydroquinone due to its skin-lightening effects, many regions have made it available only by prescription to regulate its use more strictly.

Procedures for Melasma

Melasma is a condition that we tend to treat with topicals first and use procedures only if your topical routine is unsuccessful. Here are some of our favorite procedures for melasma:

Chemical Peel

Peels involve the application of an acid to remove the top layers of the skin. Typically, six sessions every 2 – 4 weeks can help with melasma.

IPL

IPL (Intense Pulsed Light) can help reduce melasma by targeting dark spots, though it’s usually recommended for lighter skin tones due to risk of pigmentation changes.

Microneedling

Microneedling is a procedure where fine needles penetrate the skin. When combined with a medication called tranexamic acid, microneedling can lighten melasma. Typically, about 4-6 treatments are required.

PS. Final Thoughts from a Dermatologist

Melasma is TOUGH. It is chronic. We can’t give you a pill to “get rid of it.” You really just have to be VERY diligent about your sun protection. Even a few hours in the sun can flare melasma. If you can change your birth control/medications, that can help. For some conditions, we have easy procedures that can zap it away. Melasma is not one of them. You have to tinker around with your topical routine with brightening ingredients to lighten dark spots. It’s a tough condition to have! 😣 But can be controlled with mostly over-the-counter products! 😊

Melasma FAQs

How to get rid of melasma?
To get rid of melasma, use topical treatments like hydroquinone, azelaic acid, or retinoids. Sunscreen with broad-spectrum protection is essential. Procedures like chemical peels, laser therapy, or microneedling may also help under a dermatologist's supervision.

How to cure melasma from the inside?
Treating melasma from the inside involves addressing hormonal imbalances, managing stress, and maintaining a nutrient-rich diet with antioxidants like vitamin C and E. Consult a healthcare provider for personalized advice.

Can a menopausal woman get melasma?
Yes, menopausal women can get melasma. Hormonal fluctuations during menopause may trigger or worsen melasma, especially when combined with sun exposure.

Does pregabalin cause melasma?
Pregabalin is not commonly associated with causing melasma. However, medications can sometimes indirectly influence pigmentation by altering hormone levels or causing photosensitivity.

Does melasma go away?
Melasma may fade over time, especially if caused by pregnancy or birth control use. However, it can persist for years without treatment, and consistent sun protection is crucial to prevent worsening.

How to get rid of melasma mustache?
To treat melasma on the upper lip, use topical lightening agents like hydroquinone or kojic acid. Combine with sunscreen and consider professional treatments such as chemical peels or laser therapy.

Will melasma go away?
Melasma may go away on its own if triggered by temporary factors like pregnancy or certain medications. However, chronic cases often require long-term management and sun protection.

Can red light therapy make melasma worse?
Red light therapy may worsen melasma in some cases by stimulating melanocytes (pigment-producing cells). Always consult a dermatologist before using red light therapy for melasma.

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