Melasma causes flat brown or greyish patches, usually on the cheeks, forehead, nose or upper lip. The patches develop when pigment producing cells make too much melanin, the pigment that gives skin its colour. Melasma itself is harmless and does not turn into cancer, but other conditions can look similar.45

Does melasma go away on its own?

Sometimes. Melasma linked to pregnancy often fades over several months after delivery. Pigmentation associated with hormone medicines can also fade after those medicines are stopped. Discuss a possible medication trigger with your prescriber rather than changing treatment yourself. Melasma can return during another pregnancy, after restarting the same hormones or with sun exposure.13

If you are pregnant, wait until after delivery to start melasma treatment. Hydroquinone and retinoid creams should be avoided during pregnancy. Sun protection remains the practical step to take while you wait.24

How long does treatment take?

Treatment usually takes 3 to 12 months to show results. Melasma that has been present for a long time can take longer. Pigment near the skin's surface generally responds better than pigment deeper in the skin; mixed melasma, with pigment at both depths, often improves only partly. A dermatologist can assess the pigment depth to help choose treatment.156

What helps melasma fade?

Treatment often combines sun protection with prescription creams. Options include hydroquinone, a combination of hydroquinone, tretinoin and a corticosteroid, or alternatives such as azelaic acid. Creams can fade pigmentation but cannot cure melasma forever, so 'permanent removal' is an ambitious job title for a cream. Use prescription treatments on the schedule your dermatologist sets.14

Chemical peels and laser treatments are sometimes added, but they can worsen pigmentation or cause lighter patches and scarring. These are specialist options, not a shortcut around daily sun protection. Darker skin needs particular care because irritation from treatment can make pigmentation worse.124

How do you help keep melasma from returning?

  • Use broad spectrum sunscreen with SPF 30 or higher every day, including winter. Broad spectrum means protection against both UVA and UVB rays.
  • Choose sunscreen containing iron oxides for added protection against visible light, which can contribute to melasma.
  • Apply sunscreen before going outdoors. Reapply every two hours outdoors and after swimming or towel drying.
  • Wear a wide brimmed hat, seek shade and avoid tanning beds. Sunscreen supplements clothing and shade rather than replacing them.
  • Choose gentle, fragrance free skincare and avoid products that irritate your skin.
  • Continue sun protection after the patches fade. Melasma commonly darkens in summer and lightens in winter.
3456

If you want coverage while treatment works, apply melasma medication first, sunscreen next and camouflage makeup last. Camouflage makeup hides pigmentation rather than treating it, a cosmetic doing a cosmetic's actual job.14

When should you see a dermatologist?

Book an appointment if facial darkening does not go away or you are unsure it is melasma. Melasma normally is not painful or itchy, so those symptoms deserve assessment rather than more pigment treatment. Stop using irritating skincare products. If a nonprescription melasma treatment has not given the results you want within three to six months, see a dermatologist instead of continuing indefinitely.2345

Where this answer comes from

  1. 1Melasma: Diagnosis and treatmentaad.org
  2. 2Melasma: Overviewaad.org
  3. 3Melasma: MedlinePlus Medical Encyclopediamedlineplus.gov
  4. 4Melasmabad.org.uk
  5. 5Melasma: Treatment, Causes & Preventionmy.clevelandclinic.org
  6. 6Melasma (facial pigmentation)dermnetnz.org