Does melasma peel?

What should melasma look and feel like?

Melasma usually appears as brown or greyish patches on the cheeks, forehead, nose, chin or above the upper lip, often on both sides of the face. The patches are flat and usually neither itchy nor painful. The word 'patch' describes an area of colour, not a removable sticker.14

The colour comes from excess melanin, the pigment that gives skin its colour. Melasma pigment can sit in the epidermis, the outer skin layer, the dermis beneath it, or both. Removing surface cells cannot reach all deeper pigment, which helps explain why peeling is not a complete solution.56

Why is my skin peeling during melasma treatment?

Skin lightening treatments can cause redness, irritation and peeling. Hydroquinone and retinoid creams can irritate skin even when they are being used to improve pigmentation. Flaking alone is not a useful sign that the melasma is fading; look for a change in the colour instead. Irritation can worsen melasma, particularly in darker skin tones.234

What should I do if a dark patch is peeling?

1. 1Check whether the peeling began after starting a skin lightening cream or having a chemical peel. Treatments can cause peeling even though melasma itself normally does not.
2. 2Avoid irritating skincare and choose gentle, fragrance free formulas. If a prescribed treatment is causing irritation, contact the prescriber about how to proceed.
3. 3Protect the area from sunlight every day. Use broad spectrum sunscreen with SPF 30 or higher, wear a wide brimmed hat and use shade. Sunscreen containing iron oxides adds protection against visible light.
4. 4Arrange a skin examination if the darkening persists or the patch changes. Peeling, itching or pain should not simply be assumed to be melasma.

Can a chemical peel remove melasma?

A chemical peel can improve melasma by removing outer skin cells containing pigment. Superficial peels can use glycolic acid or salicylic acid. Chemical peels can improve the colour, but 'peel' is a procedure name, not a promise of a clean slate. Melasma can return, and peels can worsen pigmentation, cause excessive lightening or leave scars. Choose an experienced dermatologist, particularly one familiar with your skin tone.247

After a superficial chemical peel, redness and scaling can be part of healing. General healing time is 1 to 7 days; scaling after redness subsides can last 3 to 7 days. Follow the dermatologist's aftercare instructions and use the prescribed moisturizer. Do not rub, scratch or pick treated skin. Contact the dermatologist if the skin burns, itches or swells. These are general peel recovery times, not a timetable for clearing melasma.7

Will melasma fade without peeling?

Yes. Melasma can fade without visible peeling, including over several months after pregnancy ends. It can also persist for years. Treatment usually starts with daily sun protection and creams, rather than a procedure. Reapply sunscreen at least every two hours while outdoors. If a nonprescription treatment has not helped within three to six months, see a dermatologist rather than continuing indefinitely.13

During pregnancy, wait until after delivery to start melasma treatment. Avoid hydroquinone and retinoid creams during pregnancy. Keep using sun protection; pregnancy related pigmentation can improve after birth without treatment.34