How to help melasma

What is melasma?

Melasma is blotchy brown pigmentation, usually on both sides of the face. It happens when pigment cells called melanocytes produce too much melanin, the pigment that gives skin its color. Ultraviolet light, visible light and hormones can contribute. Family history also plays a part.3

Patches commonly affect the cheeks, forehead, nose and upper lip. Melasma itself is harmless and normally does not hurt or itch, although its appearance can cause distress. It can affect anyone, but is more common in women and people with brown skin or skin that tans easily.45

How do you protect your skin each day?

1. 1Apply any prescribed melasma medicine before sunscreen, following your prescription directions.
2. 2Apply a tinted, broad spectrum, water resistant sunscreen with SPF 30 or higher to skin not covered by clothing. Look for iron oxide to help protect against visible light.
3. 3Apply sunscreen 15 minutes before going outside. Reapply at least every two hours outdoors and protect your skin again after swimming or sweating.
4. 4Apply camouflage makeup after sunscreen if you want coverage.
5. 5When outdoors, seek shade and wear a wide brimmed hat and sunglasses with UV protection. A hat with a UPF rating gives you a stated level of ultraviolet protection.

Visible light can worsen melasma, especially in darker skin tones. A high SPF alone is not the whole sunscreen decision: choose a tint containing iron oxide as well. SPF 30 is the minimum; SPF 50 or higher is another recommended option for melasma.23

Use sunscreen throughout the year, including winter and cloudy days. Try to avoid midday sun, when ultraviolet light is most intense. Water, sand and concrete reflect sunlight, so shade and clothing still matter around these surfaces. Avoid tanning beds and sunlamps: their ultraviolet exposure can worsen melasma and interfere with treatment.25

What should you change in your skincare?

Choose gentle, fragrance free skincare. Burning or stinging means a product is irritating your skin, and irritation can darken existing spots. Stop using a product that causes those symptoms rather than treating discomfort as proof that it is working. If a prescribed treatment irritates your skin, contact the prescriber about adjusting it.2

Which treatments can help?

Treatment aims to restore your natural skin color, rather than fulfill the more ambitious promises on a brightening jar.1

• Hydroquinone is a common skin treatment that evens out pigmentation. In the United States, it requires a prescription.
• Tretinoin with a corticosteroid combines a retinoid with a medicine that reduces inflammation.
• Triple combination cream contains hydroquinone, tretinoin and a corticosteroid.
• Azelaic acid, kojic acid or vitamin C are other options a dermatologist can select, including when a gentler treatment is needed.

Makeup can hide uneven color while treatment works, which is a reasonable job description for makeup. A dermatologist can help you choose camouflage techniques that look natural.1

Does azelaic acid help with melasma?

Yes. Azelaic acid helps reduce pigmentation and is a treatment option for melasma. It suppresses tyrosinase, an enzyme involved in making pigment, and has properties that reduce inflammation. It can be useful for people with darker skin tones.67

Across six trials involving 673 people, azelaic acid performed better than hydroquinone on a melasma severity score. Other measures of pigmentation improvement and reported side effects did not differ significantly. Azelaic acid is a credible alternative, but a clear advantage over hydroquinone remains uncertain.7

Azelaic acid comes in medicinal preparations including 20% creams and 15% gels. For melasma, follow the directions for the preparation your clinician chooses rather than borrowing an acne schedule. Very sensitive skin and eczema can make azelaic acid harder to tolerate. Do not use a preparation if you are allergic to azelaic acid or one of its components.6

Stop azelaic acid and seek medical advice for severe redness, scaling, itching or burning. If asthma worsens during use, contact a doctor. Skin lightening can also occur and is more noticeable on darker skin tones.6

What if pregnancy or medication triggered melasma?

Pregnancy, hormonal contraception and hormone replacement therapy can be associated with melasma. Pregnancy related pigmentation often fades over several months after pregnancy ends. Melasma linked to hormone medicines can also fade after the medicine is stopped, but can return with another pregnancy or renewed use. Discuss a suspected medication trigger with the prescriber before changing treatment or contraception. During pregnancy, arrange a treatment plan that takes pregnancy into account rather than selecting a pigment medicine yourself.15

Should you try a peel or laser?

Chemical peels and lasers can help selected cases, but can also worsen melasma or cause extra pigmentation after inflammation. Microneedling and light treatments carry relapse risks and require expert use. These are dermatologist decisions, not substitutes for daily sun protection. Pigment reducing treatment before a procedure can be part of the plan.3

For difficult melasma, a dermatologist can consider tranexamic acid applied to the skin or taken by mouth. Oral treatment is often combined with triple combination cream and sun protection. Tell the dermatologist if you have ever had a blood clot before considering this medicine.1

How long does melasma take to fade?

Treatment usually takes 3 to 12 months to produce results, and longstanding melasma can take longer. Some melasma lasts for years. Pigment closer to the skin's surface generally responds better than pigment deeper in the skin; mixed melasma often improves only partly. Sun exposure can bring pigmentation back even after successful treatment, so sun protection remains a lasting part of care.13

When should you see a dermatologist?

Get persistent facial darkening assessed, especially before starting treatment. Other pigment conditions can resemble melasma, and some skin cancers can mimic it. A dermatologist can confirm the diagnosis and assess pigment depth with a special light or magnifying device. Tell them about medicines, hormonal treatments and how the pigmentation affects your daily life.345