Face care tips for melasma

What does melasma look like?

Melasma causes flat brown or blue grey patches, sometimes resembling freckles. Common areas include the cheeks, forehead, nose, chin and skin above the upper lip. Melasma itself is harmless and usually does not hurt or itch. However, other conditions can resemble melasma, so get new facial pigmentation assessed rather than choosing treatment from its colour alone.3

Melanocytes, the cells that make skin pigment, produce too much melanin in melasma. Light and hormonal stimulation can increase pigment production. Pregnancy, hormonal contraception, certain medicines and irritating cosmetics can contribute. Melasma often becomes darker in summer and lighter in winter, so a seasonal improvement does not necessarily mean it has disappeared.3

How should you care for your face each day?

1. 1Use gentle, fragrance free skincare. A product that burns or stings is irritating your skin and can make dark spots darker.
2. 2Apply any prescribed melasma medication as directed. When using medication, sunscreen and camouflage makeup together, apply the medication first.
3. 3Apply a tinted, broad spectrum, water resistant sunscreen with SPF 30 or higher and iron oxide. Cover skin that clothing leaves exposed, and apply it 15 minutes before going outside.
4. 4Apply camouflage makeup after sunscreen if you want to cover the patches while treatment works.
5. 5Reapply sunscreen at least every two hours outdoors and after swimming or sweating. Seek shade and wear a hat rather than relying on sunscreen alone.

Camouflage makeup can hide uneven colour while treatment works. A dermatologist can help you get natural looking coverage if you have not used camouflage makeup before.2

Why does tinted sunscreen matter?

Melasma needs protection against ultraviolet radiation and visible light. Visible light can worsen pigmentation, particularly in darker skin tones. Many sunscreens protect against ultraviolet radiation without protecting against visible light. Iron oxide in a tinted sunscreen helps address that gap. Tint is useful protection here, not just the sunscreen department's attempt to sell foundation.14

SPF describes protection against UVB, the ultraviolet rays mainly responsible for sunburn. Broad spectrum protection also covers UVA. SPF 30 or higher is the minimum used in melasma self care advice; SPF 50 or higher offers very high protection when applied sufficiently. Choose both a high SPF and broad spectrum protection, not one instead of the other.4

For melasma, choose a sunscreen with strong UVA protection as well as visible light protection. Find a tint that matches your skin tone and a finish you are willing to wear consistently. Tinted sunscreen can also camouflage pigmentation and avoid the white residue that makes some sunscreens difficult to wear. Consistent broad spectrum sunscreen use can lessen melasma severity and reduce relapses, with or without pigment reducing treatment.5

What else helps outdoors?

Sunscreen and protective clothing do not block all ultraviolet radiation, so use several forms of protection together. Wear a hat that shades your face and neck, stay in shade where possible, and minimise time outside during peak summer sunshine, roughly 10am to 4pm. An umbrella is another way to create shade. Sunscreen is part of the plan, not permission to give the sun unlimited visiting hours.4

For protective clothing, a UPF rating of 30 or higher offers good protection. Tightly woven, darker fabrics generally let less ultraviolet radiation through, and clothing that covers more skin protects more area. Change out of wet clothing after swimming because wet fabric is often less protective. Avoid intentional tanning, including tanning beds and sunlamps, which can worsen melasma and interfere with treatment.14

Should you exfoliate or use stronger skincare?

Do not keep using a cosmetic product that burns or stings in the hope that discomfort means it is working. Irritation can darken existing spots. Gentle, fragrance free products are the better starting point, especially if your skin is sensitive. If prescribed treatment irritates your skin, contact the prescriber about adjusting the plan.1

Chemical peels and lasers can treat melasma, but they can also worsen it or cause pigmentation after inflammation. Microneedling and several light and laser procedures carry a risk of relapse and melasma becoming harder to treat. These are expert treatments, not the next step after an unsuccessful scrub. Discuss procedures with a dermatologist experienced in melasma before booking one.6

Which treatments can a dermatologist offer?

Treatment usually combines sun protection with medication applied to the skin. Options include hydroquinone, tretinoin with a corticosteroid, or a combination cream containing all three. Tretinoin is a retinoid, and the corticosteroid reduces inflammation. Gentler options include azelaic acid, kojic acid or vitamin C. The choice depends on your skin tone, pigment depth and triggers; there is no single best treatment for everyone.2

For difficult melasma, a dermatologist can consider tranexamic acid applied to the skin or taken as a tablet. This requires a health review. Tell the dermatologist if you have ever had a blood clot.2

What if melasma started during pregnancy?

Pregnancy related hormonal changes can trigger melasma, and the darker colour often fades after pregnancy. Some people still have persistent patches. Daily sun protection remains central. If you are pregnant, discuss treatment choices with your clinician rather than treating the medication options above as a pregnancy routine. If pigmentation appeared after starting hormonal contraception or another medicine, discuss the possible trigger with its prescriber before changing it.136

How long does improvement take?

Treatment commonly takes 3 to 12 months to show results, and longstanding melasma can take longer. Pigment in the outer skin layer generally responds better than pigment deeper in the skin. Mixed melasma, involving both levels, usually improves only partly. A dermatologist can assess pigment depth rather than asking you to judge it from a mirror.26

Even after a good response, pigmentation can return with summer sun exposure. Treat sun protection as year round maintenance, not something to stop once patches fade. If pigmentation persists, worsens or remains bothersome, see a dermatologist to confirm the diagnosis and review treatment rather than repeatedly increasing the strength of your skincare.16