Melasma on your face: What it looks like and how to treat it

What does melasma look like?

Melasma can look tan, light brown, dark brown, grayish brown or bluish gray. Some people have broad, blotchy patches; others have smaller spots that resemble freckles. The cheeks, forehead, nose, chin and skin above the upper lip are common locations. The patches usually appear on both sides of the face and feel flat rather than raised. Less commonly, melasma affects the arms, neck or other areas.1

Typical melasma changes skin color without causing pain, itching or discomfort. Melasma itself is not cancer and does not turn into cancer. However, other conditions can resemble it, including age spots, pigmentation left after inflammation and some skin cancers. A patch that hurts or itches should not automatically be treated as melasma. A dermatologist can examine the discoloration and, when needed, use a Wood's lamp, a light that helps assess pigment, or take a small skin sample.2

Why does melasma occur?

Melanin is the pigment that gives skin its color. Cells called melanocytes produce it, and sun exposure stimulates more production. Melasma involves excess pigment production in affected areas. Having naturally darker skin does not replace sunscreen: melanin absorbs some harmful ultraviolet light, but does not provide enough protection against sun damage on its own.3

Light and hormones are major triggers. Ultraviolet light and visible light can stimulate pigmentation, while pregnancy, birth control pills and hormone replacement therapy are associated with melasma. Family history also plays a role. Certain medicines and irritating or scented products can contribute. Melasma is more common in women and people with brown skin or skin that tans easily, although anyone can develop it. The pattern is often seasonal, with darker patches in summer and lighter patches in winter.245

How do you treat melasma?

Treatment usually starts with sun protection and creams applied to the patches. A dermatologist can tailor the plan to your skin tone and the discoloration. Treating melasma sooner is preferable to waiting years, when noticeable improvement can become harder. Darker skin needs particular care because irritation from treatment can deepen pigmentation, and results often take longer. Some people need prescription creams, a procedure or both rather than another nonprescription product.1

What should your daily routine include?

1. 1Use gentle, fragrance free skincare. Stop using a product that burns or stings, because irritation can darken the spots.
2. 2Apply sunscreen to exposed skin 15 minutes before going outside. Choose broad spectrum protection against UVA and UVB, water resistance and SPF 30 or higher.
3. 3For visible light protection, choose a tinted sunscreen containing iron oxide. Visible light can worsen melasma, especially in darker skin tones.
4. 4While outdoors, reapply sunscreen at least every two hours and renew protection after swimming or sweating. Seek shade and wear a wide brimmed hat and sunglasses with UV protection.

Use sun protection every day, including cloudy days. Stay out of tanning beds and do not use sunlamps, which can worsen melasma and interfere with treatment. A hat with an ultraviolet protection factor, or UPF, on its label provides a stated level of protection, which gives the label something useful to discuss besides the hat. Makeup is optional while you wait for treatment to work.6

Continue sunscreen through winter rather than reserving it for summer. Avoid midday sun where possible, when ultraviolet light is most intense. Water, sand and concrete reflect sunlight, so exposure is not limited to light arriving directly from above. Sun protection also includes clothing that covers exposed skin. These measures reduce exposure that can trigger melasma, including after the original discoloration has faded.5

Which creams and procedures can help?

A combination cream containing hydroquinone, tretinoin and a topical steroid is a leading treatment option. Other topical treatments include azelaic acid, cysteamine, kojic acid, thiamidol and tranexamic acid, used alone or in combinations. These are options to discuss, not a shopping list to apply together. Your treatment plan should specify which medicine to use and how to apply it.4

Chemical peels and lasers require caution because they can worsen melasma or cause pigmentation after inflammation. Laser, intense pulsed light and microneedling procedures also carry risks of relapse and more resistant discoloration, so expert selection matters. Pigment near the skin's surface generally responds better than deeper pigment; mixed melasma often improves only partly.24

Can tranexamic acid help with melasma?

Tranexamic acid is used for melasma both as a topical treatment and as an oral medicine. Oral tranexamic acid acts on pathways involved in pigment production. A skincare product containing tranexamic acid and a prescribed tablet are different treatment choices, not interchangeable versions of the same routine. Discuss oral treatment with a dermatologist rather than treating it as an extension of a serum.4

How long does melasma take to fade?

Melasma responds slowly, especially when it has been present for a long time. It can last for years, even though some cases fade without treatment. Melasma can return after treatment, which gives 'gone forever' more work than a cream can reasonably accept. Protecting the skin from sunlight remains necessary after improvement. If a nonprescription treatment has not produced the results you want within three to six months, see a dermatologist instead of continuing indefinitely.14

What if you are pregnant or taking hormone medicines?

During pregnancy, focus on sun protection and wait until after birth to start melasma treatment. Nonprescription availability does not mean a lightening treatment is safe during pregnancy. Pregnancy related melasma often fades over several months after birth. If patches appeared while taking hormonal contraception or hormone replacement therapy, discuss the medicine with your prescriber before making a change. Melasma can return during another pregnancy or when hormone medicines are used again. Contact a healthcare professional if facial darkening does not go away.15