Can melasma on the face be cured?

What is melasma and how is it treated?

Melasma causes flat brown or greyish patches, commonly on the cheeks, forehead, nose, upper lip and chin. The patches often appear on both sides of the face. Melasma itself is harmless and is not cancerous, but another condition can resemble it, so new or persistent facial pigmentation deserves a diagnosis rather than a shopping list.134

Melanin is the pigment that gives skin its colour. Melasma develops when pigment producing cells make too much of it. Natural melanin offers some protection from ultraviolet light, but it does not replace sunscreen. Treatment usually combines sun protection, medicines applied to the skin and, sometimes, a procedure.256

Can melasma be cured permanently?

Clearer skin is possible; permanent clearance is not something treatment can promise. Pigmentation can return with sun exposure, another pregnancy or renewed use of a hormonal medicine. Even a good response needs ongoing sun protection. Treatment aims to reduce excess pigment and restore a more even skin tone, not issue a lifetime warranty.236

Why does melasma develop?

The exact cause is complex. Sunlight, hormonal changes and a family tendency contribute. Melasma is more common in women and people with brown skin or skin that tans easily, although anyone can develop it. Pregnancy, birth control pills and hormone replacement therapy are common hormonal associations. Some medicines and irritating cosmetics can also contribute.1346

Visible light can worsen melasma, especially in darker skin tones. That does not mean your phone needs a skincare ban: there is no evidence that blue light from personal electronic devices affects the skin. Focus on protection from sunlight rather than buying products specifically to counter your screen.17

How to protect your face each day

1. 1Choose gentle, fragrance free skincare. Stop using a cosmetic that burns or stings, because irritation can darken the patches.
2. 2Apply any prescribed melasma medicine in the order and frequency your dermatologist gives you. When layering with sunscreen and makeup, medicine goes first.
3. 3Apply a tinted, broad spectrum, water resistant sunscreen with SPF 30 or higher and iron oxide. SPF 50 or higher is another option for strong sun protection.
4. 4Apply sunscreen 15 minutes before going outdoors. Reapply at least every two hours outside and after swimming or sweating.
5. 5Add makeup after sunscreen if you want coverage. Camouflage makeup can hide uneven colour while treatment takes effect.
6. 6Wear a hat with a wide brim, seek shade and avoid tanning beds and sunlamps. Continue sun protection throughout the year, including cloudy days.

Sunscreen helps prevent new patches and darkening of existing ones. Iron oxide adds protection against visible light. A hat and shade belong alongside sunscreen, even if neither arrives in a bottle with an ambitious product name. No sunscreen provides complete protection on its own.12

Which creams and medicines help?

Hydroquinone reduces pigment production. It is a prescription treatment that needs medical supervision: irritation, excessive lightening and occasional darkening are possible. Retinoid creams can also improve melasma but can irritate skin. Neither should be treated as an indefinite daily cosmetic.1

A triple combination cream contains hydroquinone, tretinoin and a corticosteroid that reduces inflammation. Other options include azelaic acid, kojic acid, vitamin C, cysteamine and thiamidol. A dermatologist can choose a gentler option when needed and tailor the plan to your skin tone, pigment depth and triggers. Do not copy someone else's prescription schedule.12

For stubborn melasma, a dermatologist can consider tranexamic acid, applied to the skin or taken by mouth. Oral treatment requires a health assessment. Tell the prescriber if you have ever had a blood clot before considering this medicine.2

Can lasers or peels remove melasma?

Chemical peels remove pigment containing surface cells. Laser and light treatments, or microneedling, are sometimes added to medicines and sun protection. They are not permanent cures. Peels and lasers can worsen pigmentation, and some procedures carry a substantial risk of relapse or melasma becoming harder to treat.16

Possible complications include scarring, infection after microneedling, and patches of lighter skin after laser treatment. Pigment changes after lasers are more frequent in people of colour. Use an experienced, qualified dermatologist who understands your skin tone rather than choosing a procedure solely because it promises faster results.1

What changes during pregnancy?

Pregnancy related melasma can fade over several months after delivery, so treatment is not always necessary. Avoid hydroquinone and retinoid creams during pregnancy. Sun protection remains useful. If a hormonal medicine appears to be a trigger, discuss alternatives with its prescriber rather than stopping a prescription yourself.13

How long does improvement take?

Treatment usually takes 3 to 12 months to show results, and longstanding melasma can take longer. Pigment in the outer skin layer generally responds better than deeper pigment. Mixed melasma, with pigment at both depths, often improves only partly. A dermatologist can assess pigment depth with a Wood's lamp or dermatoscope, devices used to examine the skin.26

Photographs taken over time can help monitor the response. Camouflage makeup provides coverage while you wait; its job is to hide pigment, not submit a cure claim. Makeup is optional, and a dermatologist can help you find a natural looking match.67

When should you see a doctor?

Arrange an assessment for facial darkening that does not go away, or a patch that changes. Typical melasma is flat and does not itch or hurt; raised, painful or itchy areas should not automatically be treated as melasma. If a prescribed cream irritates your skin or pigmentation worsens during treatment, contact the prescriber before continuing.13