What should you do about melasma with skin irritation?

Is the irritation actually melasma?

Typical melasma consists of flat brown or greyish patches, often on both sides of the face. Hydroquinone and retinoid creams used to treat those patches can cause irritation. Redness or inflammation can also occur alongside melasma, so symptoms alone cannot identify the cause. A dermatologist can distinguish melasma from other pigmentation problems, including postinflammatory hyperpigmentation, which means dark marks left after inflammation.123

What should you do now?

1. 1Stop skincare that irritates the affected area. If hydroquinone causes marked redness, scaling, itching or weeping, discontinue it and contact the prescriber before restarting.
2. 2Wash with a mild cleanser and warm rather than hot water. Avoid antibacterial or deodorant soaps that can dry the skin.
3. 3Apply a fragrance free moisturizer after washing. After a shower or bath, apply it within five minutes to help trap water in the skin, and use it again when skin feels dry.
4. 4Apply sunscreen as part of your morning routine, before going outdoors. Use shade and a wide brimmed hat as well.

These cleansing and moisturizing steps are general care for dry, irritated skin, not a pigment treatment.5

Which sunscreen makes sense if your skin stings?

For melasma, choose broad spectrum SPF 50 or higher with iron oxides, which add protection against visible light. Look for water resistance too. If sunscreen burns or stings, try one whose sunscreen filters are only zinc oxide and titanium dioxide, and avoid fragrance. A tinted sunscreen can also reduce white residue. Sunscreen shopping means reading protection claims, not choosing the bottle with the most convincing beach on it.136

Apply plenty of sunscreen 15 to 30 minutes before sun exposure. Reapply every two hours outdoors and straight after swimming or towel drying. Sun protection helps melasma treatment work and remains necessary after pigmentation improves; sunscreen does not replace clothing and shade.1

Can you restart a pigment treatment?

Review an irritating prescription with the prescriber rather than increasing its strength. Hydroquinone above 4% can cause irritant contact dermatitis, an inflammatory reaction to an irritating substance. A brief treatment break can settle a mild reaction. Combination creams sometimes include a weak steroid to reduce irritation, but these need medical supervision; do not add a steroid yourself.14

When starting prescribed hydroquinone, test an area about 1 cm across and check for redness or irritation over 24 hours. General starting guidance is a thin film once daily on pigmented skin only, avoiding the eyes and mouth. Increasing frequency requires a week without irritation and agreement with your prescribed directions. Wait 10 minutes before sunscreen or cosmetics, and avoid adding other topical medicines, particularly benzoyl peroxide.4

Avoid hydroquinone and retinoid creams during pregnancy. Hydroquinone safety during breastfeeding is uncertain, so discuss an alternative with your clinician.14

What should you expect, and when should you get help?

Pigment improvement takes patience: hydroquinone effects can become visible after five to seven weeks, while significant improvement can take several months. Melasma often returns, especially with sun exposure. If hydroquinone has brought no benefit after three months, stop and review the plan rather than continuing indefinitely.347

See a dermatologist if irritation lingers or worsens, or if the patches have not been diagnosed. Avoid treating irritation as a reason to book a peel or laser: these procedures can worsen melasma or cause additional pigmentation and require experienced practitioners.35